Basic Information
| Provider Information | |||||||||
| NPI: | 1659387561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIRFEL | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WEST LOOP S | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774014104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135728122 | ||||||||
| FaxNumber: | 7135720753 | ||||||||
| Practice Location | |||||||||
| Address1: | 6700 WEST LOOP S | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774014104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135728122 | ||||||||
| FaxNumber: | 7135720753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 01/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | K2140 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 8P5716 | 01 | TX | BCBSTX | OTHER | 143164502 | 05 | TX | MEDICAID |