1396984795 NPI number — DR. CORINNA MARIA KEENMON M.D.

Table of content: KRISTINA R SCHROEDER DPT (NPI 1780972737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396984795 NPI number — DR. CORINNA MARIA KEENMON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEENMON
Provider First Name:
CORINNA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396984795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4545 BISSONNET ST
Provider Second Line Business Mailing Address:
SUITE NUMBER 271
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77401-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-795-4441
Provider Business Mailing Address Fax Number:
713-795-5034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4545 BISSONNET ST
Provider Second Line Business Practice Location Address:
SUITE NUMBER 271
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77401-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-795-4441
Provider Business Practice Location Address Fax Number:
713-795-5034
Provider Enumeration Date:
02/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  44310 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: P7480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: P7480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: A116957 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BP10028757 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P7480 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A116957 . This is a "THE MEDICAL BOARD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".