Provider Demographics
NPI:1407802119
Name:RAPP, KADISHA B (MD)
Entity Type:Individual
Prefix:
First Name:KADISHA
Middle Name:B
Last Name:RAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 BROWNWAY ST
Mailing Address - Street 2:1502
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4932
Mailing Address - Country:US
Mailing Address - Phone:713-654-0020
Mailing Address - Fax:
Practice Address - Street 1:5250 BROWNWAY ST
Practice Address - Street 2:1502
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4932
Practice Address - Country:US
Practice Address - Phone:713-654-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422412207P00000X
TXM7556207P00000X
DCMD043229207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100841645Medicaid
H95498Medicare UPIN
H95498Medicare UPIN