Provider Demographics
NPI:1083662670
Name:GEORGIOU, KIM D (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:GEORGIOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FERGUSON WAY
Mailing Address - Street 2:
Mailing Address - City:POINTBLANK
Mailing Address - State:TX
Mailing Address - Zip Code:77364-6581
Mailing Address - Country:US
Mailing Address - Phone:713-202-8289
Mailing Address - Fax:
Practice Address - Street 1:104 N BEECH ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4718
Practice Address - Country:US
Practice Address - Phone:409-283-2822
Practice Address - Fax:409-283-7852
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26996207Q00000X
TXN5074207Q00000X
AK5754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00358143OtherRR MEDICARE
OR135537Medicare PIN
ORI48019Medicare UPIN