Provider Demographics
NPI:1659387561
Name:WIRFEL, KELLY L (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:WIRFEL
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 1:6700 WEST LOOP S
Mailing Address - Street 2:SUITE 520
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4104
Mailing Address - Country:US
Mailing Address - Phone:713-572-8122
Mailing Address - Fax:713-572-0753
Practice Address - Street 1:6700 WEST LOOP S
Practice Address - Street 2:SUITE 520
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4104
Practice Address - Country:US
Practice Address - Phone:713-572-8122
Practice Address - Fax:713-572-0753
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2140207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P5716OtherBCBSTX
TX143164502Medicaid
TX85014FMedicare PIN
TX8P5716OtherBCBSTX
TX8L1281Medicare PIN