Provider Demographics
NPI:1922412584
Name:KMA DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:KMA DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:W
Authorized Official - Last Name:CIESLEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-960-4461
Mailing Address - Street 1:10330 LAKE RD STE M
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1886
Mailing Address - Country:US
Mailing Address - Phone:713-960-4461
Mailing Address - Fax:
Practice Address - Street 1:10330 LAKE RD STE M
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1886
Practice Address - Country:US
Practice Address - Phone:713-960-4461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty