Provider Demographics
NPI:1114983061
Name:KAILASAM, JAYASREE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYASREE
Middle Name:
Last Name:KAILASAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAYASREE
Other - Middle Name:
Other - Last Name:THYAGARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2914 HAVERLING DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9157
Mailing Address - Country:US
Mailing Address - Phone:713-924-8521
Mailing Address - Fax:713-526-6369
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:820
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-528-1916
Practice Address - Fax:713-526-6369
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG80761Medicare UPIN