Provider Demographics
NPI:1932073368
Name:NORTHEAST MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:NORTHEAST MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DELANEY
Authorized Official - Last Name:KYLES
Authorized Official - Suffix:IV
Authorized Official - Credentials:NP
Authorized Official - Phone:713-249-8236
Mailing Address - Street 1:PO BOX 15054
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77220-5054
Mailing Address - Country:US
Mailing Address - Phone:713-249-8236
Mailing Address - Fax:
Practice Address - Street 1:1454 LOCKWOOD DR STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-4700
Practice Address - Country:US
Practice Address - Phone:713-249-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty