1306847215 NPI number — UMANG KHETARPAL M.D.

Table of content: UMANG KHETARPAL M.D. (NPI 1306847215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306847215 NPI number — UMANG KHETARPAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHETARPAL
Provider First Name:
UMANG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1306847215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/22/2006
NPI Reactivation Date:
04/03/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 MEDICAL PLAZA DRIVE
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-990-2700
Provider Business Mailing Address Fax Number:
832-789-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W 26TH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-990-2700
Provider Business Practice Location Address Fax Number:
832-789-9400
Provider Enumeration Date:
08/02/2005

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: 207YX0007X , with the licence number:  L0330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 044807801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8A1410 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 040015446 . This is a "MEDICARE PIN (RAILROAD)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".