Provider Demographics
NPI:1083771976
Name:KREIT, MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:KREIT
Suffix:
Gender:M
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:PO BOX 1816
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77328
Mailing Address - Country:US
Mailing Address - Phone:281-592-2426
Mailing Address - Fax:281-593-0060
Practice Address - Street 1:212 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327
Practice Address - Country:US
Practice Address - Phone:281-592-2426
Practice Address - Fax:281-539-0060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121245802Medicaid
00T174Medicare PIN
TX00T17HMedicare ID - Type Unspecified
TX121245802Medicaid