MEDICARE: DR. KASHIF H ANSARI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	L3557	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8M8310	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1164405023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KASHIF H ANSARI M.D.

Provider Business Mailing Address
First Line	:	1610 W BAKER RD
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77521-2279
Country	:	US
Telephone Number	:	281-837-2288
Fax Number	:	281-837-2252

Provider Business Practice Location Address
First Line	:	1610 W BAKER RD
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77521-2279
Country	:	US
Telephone Number	:	281-837-2288
Fax Number	:	281-837-2252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	12/16/2009

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