Provider Demographics
NPI:1730399668
Name:BOUTROS P. KAHLA, M.D., P.A.
Entity type:Organization
Organization Name:BOUTROS P. KAHLA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOUTROS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAHLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-428-4001
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:STE 313
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3156
Mailing Address - Country:US
Mailing Address - Phone:281-428-4001
Mailing Address - Fax:281-428-4044
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:STE 313
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3156
Practice Address - Country:US
Practice Address - Phone:281-428-4001
Practice Address - Fax:281-428-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0064PVOtherBCBS
TX189686201Medicaid
TX00Y018Medicare PIN