1386693406 NPI number — NILESHKUMAR M CHAUDHARI MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386693406 NPI number — NILESHKUMAR M CHAUDHARI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAUDHARI
Provider First Name:
NILESHKUMAR
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386693406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15015 KIRBY DR STE 200B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77047-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-456-4412
Provider Business Mailing Address Fax Number:
281-205-8356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15015 KIRBY DR STE 200B
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:
77047-2580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-456-4412
Provider Business Practice Location Address Fax Number:
281-205-8356
Provider Enumeration Date:
05/08/2006

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: 207X00000X , with the licence number:  29226 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03737319 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00912096 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 113241 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051049990 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051049989 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051049988 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 113235 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113239 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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