Basic Information
| Provider Information | |||||||||
| NPI: | 1356323943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EBERLE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 2070 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137047103 | ||||||||
| FaxNumber: | 7137041796 | ||||||||
| Practice Location | |||||||||
| Address1: | 10905 MEMORIAL HERMANN DR | ||||||||
| Address2: | STE 115 | ||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775843490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139473100 | ||||||||
| FaxNumber: | 7137041796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | L1025 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0035TD | 01 | TX | BLUE CROSS BLUE SHIELD OF TEXAS GROUP RECORD NUMBER | OTHER | 00X185 | 01 | TX | MEDICARE GROUP PTAN - BRAZORIA | OTHER | DB6392 | 01 | RAILROAD MEDICARE GROUP PTAN | OTHER | 153449704 | 01 | TX | MEDICAID GROUP TPI | OTHER | 8DC609 | 01 | TX | BLUE CROSS BLUE SHIELD INDIVIDUAL RECORD NUMBER | OTHER | 00106W | 01 | TX | MEDICARE GROUP PTAN - HARRIS | OTHER |