Provider Demographics
NPI:1932384435
Name:KAHTAN A. KAISSI, MD
Entity Type:Organization
Organization Name:KAHTAN A. KAISSI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAHTAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAISSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-3437
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-3949
Mailing Address - Country:US
Mailing Address - Phone:409-722-3437
Mailing Address - Fax:409-722-1281
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-3949
Practice Address - Country:US
Practice Address - Phone:409-722-3437
Practice Address - Fax:409-722-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1491261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B4031OtherBCBS PROVIDER ID NO.
TX8B4030OtherBCBS PROVIDER ID
TXG33367Medicare UPIN
TX00994MMedicare PIN
TX8B4030OtherBCBS PROVIDER ID
TX00892JMedicare PIN