Provider Demographics
NPI:1750866927
Name:CMC MEDICAL PLLC
Entity Type:Organization
Organization Name:CMC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LLEWELLYN
Authorized Official - Middle Name:BASILIO
Authorized Official - Last Name:CANIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-378-0989
Mailing Address - Street 1:1017 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2903
Mailing Address - Country:US
Mailing Address - Phone:713-378-0989
Mailing Address - Fax:713-378-0963
Practice Address - Street 1:1017 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2903
Practice Address - Country:US
Practice Address - Phone:713-378-0989
Practice Address - Fax:713-378-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty