Individual
DR. KEVIN THELEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1643 LANCASTER DR, SUITE 203, GRAPEVINE, TX 76051-3593
(817) 329-7670
(817) 416-0145
Mailing address
1643 LANCASTER DR, SUITE 203, GRAPEVINE, TX 76051-3593
(817) 329-7670
(817) 416-0145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
K8694
TX
207RC0000X
Cardiovascular Disease Physician
Primary
K8694
TX
207RI0011X
Interventional Cardiology Physician
K8694
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145340904
—
TX
05
—
145340905
—
TX
01
—
8CM934
BCBSTX
TX
Enumeration date
06/14/2006
Last updated
06/28/2011
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