Provider Demographics
NPI:1134576135
Name:KIELHORN, CAMERON MAXWELL (DO)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:MAXWELL
Last Name:KIELHORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E US HWY 290
Mailing Address - Street 2:STE 240 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1144
Mailing Address - Country:US
Mailing Address - Phone:512-338-3826
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:27600 RANCH ROAD 12 BLDG 1
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5612
Practice Address - Country:US
Practice Address - Phone:512-676-2500
Practice Address - Fax:512-406-7377
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361375404Medicaid
TX361375403Medicaid