Provider Demographics
NPI:1033221213
Name:HOUSTON INFECTIOUS DISEASES ASSOCIATED
Entity Type:Organization
Organization Name:HOUSTON INFECTIOUS DISEASES ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIELHOFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-791-4882
Mailing Address - Street 1:6624 FANNIN
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-791-4882
Mailing Address - Fax:713-791-4159
Practice Address - Street 1:6624 FANNIN
Practice Address - Street 2:SUITE 1410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-791-4882
Practice Address - Fax:713-791-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
82T4CHOtherBLUE CROSS
89C792OtherBLUE CROSS
89C793OtherBLUE CROSS
82T4ACOtherBLUE CROSS
82T4CMOtherBLUE CROSS
89C794OtherBLUE CROSS
82T474OtherBLUE CROSS
89C791OtherBLUE CROSS
89C791OtherBLUE CROSS
F77702Medicare UPIN
82T4CMOtherBLUE CROSS
ZE089C272Medicare ID - Type Unspecified
89C794OtherBLUE CROSS
89C793OtherBLUE CROSS
TX00QW03Medicare ID - Type Unspecified
=========OtherTAX ID
82T4ACOtherBLUE CROSS
C51373Medicare UPIN