Provider Demographics
NPI:1366879405
Name:FAMILY MEDICINE & SENIOR CARE PLLC
Entity type:Organization
Organization Name:FAMILY MEDICINE & SENIOR CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UME-HANEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-694-3433
Mailing Address - Street 1:PO BOX 10890
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0890
Mailing Address - Country:US
Mailing Address - Phone:979-694-3433
Mailing Address - Fax:
Practice Address - Street 1:1304 DEACON DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6405
Practice Address - Country:US
Practice Address - Phone:979-694-3433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1903207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty