1578751988 NPI number — KATY INTERNISTS, MD PA

Table of content: (NPI 1578751988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578751988 NPI number — KATY INTERNISTS, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATY INTERNISTS, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578751988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18400 KATY FWY STE 590
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:
77094-1291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-781-2002
Provider Business Mailing Address Fax Number:
281-578-1255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18400 KATY FWY STE 590
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:
77094-1291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-781-2002
Provider Business Practice Location Address Fax Number:
281-578-1255
Provider Enumeration Date:
10/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASADUDDIN
Authorized Official First Name:
ADIL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
847-910-4413

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , with the licence number: L5230 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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