Provider Demographics
NPI:1336511484
Name:KOLLER, KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:KOLLER
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 1:3607 EL DORADO OAKS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-4041
Mailing Address - Country:US
Mailing Address - Phone:713-241-7198
Mailing Address - Fax:
Practice Address - Street 1:910 LOUISIANA ST
Practice Address - Street 2:ROOM 17074
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-4916
Practice Address - Country:US
Practice Address - Phone:713-241-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ35192083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine