Provider Demographics
NPI:1952593386
Name:KIDANE, ALISHA K (MD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:K
Last Name:KIDANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:D
Other - Last Name:KITHCART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1615 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-8525
Mailing Address - Country:US
Mailing Address - Phone:713-222-2272
Mailing Address - Fax:
Practice Address - Street 1:1615 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-8525
Practice Address - Country:US
Practice Address - Phone:713-222-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0617OtherTEXAS MEDICAL BOARD