Provider Demographics
NPI:1356323943
Name:EBERLE, KATHLEEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:H
Last Name:EBERLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6400 FANNIN ST STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-704-7103
Mailing Address - Fax:713-704-1796
Practice Address - Street 1:10905 MEMORIAL HERMANN DR
Practice Address - Street 2:STE 115
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3490
Practice Address - Country:US
Practice Address - Phone:713-947-3100
Practice Address - Fax:713-704-1796
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL10252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035TDOtherBLUE CROSS BLUE SHIELD OF TEXAS GROUP RECORD NUMBER
TX00X185OtherMEDICARE GROUP PTAN - BRAZORIA
DB6392OtherRAILROAD MEDICARE GROUP PTAN
TX153449704OtherMEDICAID GROUP TPI
TX8DC609OtherBLUE CROSS BLUE SHIELD INDIVIDUAL RECORD NUMBER
TX00106WOtherMEDICARE GROUP PTAN - HARRIS
TX00X185OtherMEDICARE GROUP PTAN - BRAZORIA
H56661Medicare UPIN
TXTXB150042Medicare PIN