1194916379 NPI number — DR. KIDADA NATAKI GILBERT-LEWIS MD, MPH

Table of content: DR. KIDADA NATAKI GILBERT-LEWIS MD, MPH (NPI 1194916379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194916379 NPI number — DR. KIDADA NATAKI GILBERT-LEWIS MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERT-LEWIS
Provider First Name:
KIDADA
Provider Middle Name:
NATAKI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1194916379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9100 FONDREN RD
Provider Second Line Business Mailing Address:
APT. 252
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074-6999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-796-8651
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6411 FANNIN ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-500-5301
Provider Business Practice Location Address Fax Number:
713-500-0732
Provider Enumeration Date:
08/05/2007

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: 207ZC0500X , with the licence number:  N2529 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZC0500X , with the licence number: BP1-0029089 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4661832094 . This is a "MYUTMB 4661832094" identifier . This identifiers is of the category "OTHER".




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