Provider Demographics
NPI:1275592800
Name:ALO, KENNETH MARK (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MARK
Last Name:ALO
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 1:2001 HERMANN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7643
Mailing Address - Country:US
Mailing Address - Phone:713-796-3209
Mailing Address - Fax:713-583-1841
Practice Address - Street 1:2001 HERMANN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7643
Practice Address - Country:US
Practice Address - Phone:713-796-3209
Practice Address - Fax:713-583-1841
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7865207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C1318Medicare ID - Type Unspecified
TXE95887Medicare UPIN