Individual
DR. KENNETH M DIREKLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6720 BERTNER ST, HOUSTON, TX 77030-2604
(832) 355-2121
Mailing address
6720 BERTNER AVE, HOUSTON, TX 77030
(832) 355-2121
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M0056
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171487504
—
TX
05
—
171487505
—
TX
01
—
8W7272
BCBS
TX
Enumeration date
07/17/2006
Last updated
07/29/2009
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