Provider Demographics
NPI:1790012870
Name:GILDERSLEEVE, KASEY L (MD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:L
Last Name:GILDERSLEEVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 HARGRAVE RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4373
Mailing Address - Country:US
Mailing Address - Phone:281-737-1167
Mailing Address - Fax:
Practice Address - Street 1:13300 HARGRAVE RD
Practice Address - Street 2:SUITE 505
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4373
Practice Address - Country:US
Practice Address - Phone:281-737-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361670402084N0400X, 2084V0102X
VA01012801252084N0400X
TXP68222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347144301Medicaid
TX347144302Medicaid
TX8FD120OtherBLUE CROSS BLUE SHIELD
TXP01556692OtherRR MEDICARE
TX8FD120OtherBLUE CROSS BLUE SHIELD