Provider Demographics
NPI:1811484801
Name:KIDNEY SPECIALISTS OF THE WOODLANDS AND CONROE
Entity type:Organization
Organization Name:KIDNEY SPECIALISTS OF THE WOODLANDS AND CONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-520-8983
Mailing Address - Street 1:4015 I 45 N STE 310
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5077
Mailing Address - Country:US
Mailing Address - Phone:936-520-8983
Mailing Address - Fax:936-463-6508
Practice Address - Street 1:4015 I 45 N STE 310
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5077
Practice Address - Country:US
Practice Address - Phone:936-520-8983
Practice Address - Fax:936-463-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty