Provider Demographics
NPI:1407954738
Name:ELLIOTT, KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:ELLIOTT
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 1:2300 GREEN OAK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2051
Mailing Address - Country:US
Mailing Address - Phone:281-359-4111
Mailing Address - Fax:281-359-4447
Practice Address - Street 1:2300 GREEN OAK DR STE 300
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2051
Practice Address - Country:US
Practice Address - Phone:281-359-4111
Practice Address - Fax:281-359-4447
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097846201Medicaid
TX88449FMedicare ID - Type Unspecified