Provider Demographics
NPI:1720474778
Name:ICARE MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:ICARE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-819-1764
Mailing Address - Street 1:6800 WEST LOOP S STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4528
Mailing Address - Country:US
Mailing Address - Phone:713-838-0800
Mailing Address - Fax:713-838-0887
Practice Address - Street 1:3607 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4311
Practice Address - Country:US
Practice Address - Phone:713-838-0800
Practice Address - Fax:713-838-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty