MEDICARE: CENTERS FOR DIABETES MANAGEMENT LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center
2	261QH0100X	Health Service Clinic/Center	005447	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005447	OTHER	TX	ADA ERP RECOGNITION

General Provider Information

NPI Number	:	1679645246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERS FOR DIABETES MANAGEMENT LLC.

Provider Business Mailing Address
First Line	:	24046 HWY 59N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1500
Country	:	US
Telephone Number	:	281-358-3387
Fax Number	:	281-312-4445

Provider Business Practice Location Address
First Line	:	24046 HWY 59N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1500
Country	:	US
Telephone Number	:	281-358-3387
Fax Number	:	281-312-4445

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	CAMIL I. KREIT
Credential	:	MD
Telephone Number	:	281-852-9000

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/04/2009

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