Provider Demographics
NPI:1396210910
Name:MONTGOMERY INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:MONTGOMERY INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:METHUKU
Authorized Official - Last Name:KURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-444-7123
Mailing Address - Street 1:11 SPRUCE CANYON PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2758
Mailing Address - Country:US
Mailing Address - Phone:973-444-7123
Mailing Address - Fax:
Practice Address - Street 1:425 HOLDERRIETH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4551
Practice Address - Country:US
Practice Address - Phone:973-444-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty