Provider Demographics
NPI:1194912931
Name:ROBERT D KAVIEFF
Entity type:Organization
Organization Name:ROBERT D KAVIEFF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KAVIEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-427-1450
Mailing Address - Street 1:1600 JAMES BOWIE DR STE D105
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3300
Mailing Address - Country:US
Mailing Address - Phone:281-427-1450
Mailing Address - Fax:281-427-9440
Practice Address - Street 1:1600 JAMES BOWIE DR STE D105
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3300
Practice Address - Country:US
Practice Address - Phone:281-427-1450
Practice Address - Fax:281-427-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T90EMedicaid
TX00T90EMedicaid
TX00T90EMedicare PIN