Provider Demographics
NPI:1912946815
Name:GALUSHA, KIMBERLY (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GALUSHA
Suffix:
Gender:F
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:PO BOX 151779
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1779
Mailing Address - Country:US
Mailing Address - Phone:512-609-8370
Mailing Address - Fax:512-609-8032
Practice Address - Street 1:2310 BLISS SPILLAR RD
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-4400
Practice Address - Country:US
Practice Address - Phone:512-609-8370
Practice Address - Fax:512-609-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036CJOtherBCBS INDIVIDUAL
TX110170560OtherRAILROAD MEDICARE
TXF95895Medicare UPIN
TX110170560OtherRAILROAD MEDICARE