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Organization
KMCI SERVICE MANAGEMENT, LLC
Active
Organization
KMCI SERVICE MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AVIAN DESHIVER KIDD MD (PRESIDENT)
(972) 505-1584
Entity
Organization
Contact information
Practice address
3131 MCKINNEY AVE, SUITE 600, DALLAS, TX 75204-7426
(972) 505-1584
(682) 422-3020
Mailing address
3131 MCKINNEY AVE, SUITE 600, DALLAS, TX 75204-7426
(972) 505-1584
(682) 422-3020
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M1829
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M1829
LICENSE
TX
Enumeration date
03/28/2013
Last updated
09/05/2013
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