Provider Demographics
NPI:1396730826
Name:KITTEN, CLIFFORD MARK (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:MARK
Last Name:KITTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:118 SHENANDOAH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1204
Mailing Address - Country:US
Mailing Address - Phone:281-583-4000
Mailing Address - Fax:281-580-5079
Practice Address - Street 1:118 SHENANDOAH DR
Practice Address - Street 2:SUITE A
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77381-1204
Practice Address - Country:US
Practice Address - Phone:281-583-4000
Practice Address - Fax:281-580-5079
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4456208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1227209-03Medicaid
TXB23996Medicare UPIN
TX86X682Medicare PIN