MEDICARE: INSIGHT MEDICAL DIAGNOSTICS

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1194936278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT MEDICAL DIAGNOSTICS

Provider Business Mailing Address
First Line	:	2225 WILLIAMS TRACE BLVD
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4513
Country	:	US
Telephone Number	:	281-491-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 WILLIAMS TRACE BLVD
Second Line	:	SUITE 102
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4513
Country	:	US
Telephone Number	:	281-491-0144
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	WILLIAM CRAIG BRENAN
Credential	:
Telephone Number	:	713-498-1543

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	09/07/2007

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1184610529 — DR. CARL R MEISNER MD
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2225 WILLIAMS TRACE BLVD , 110
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1598731309 — EDWARD J HURWITZ MD
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1669482550 — CUSTOMIZED HEALTH CARE SERVICES,INC.
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1659481919 — PAULA M. BROMAN MSPT
Practice Location Address:

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1053421396 — MICHELLE L HEEBNER LPT
Practice Location Address:

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1205946464 — BARRY A BROMAN MSPT
Practice Location Address:

2225 WILLIAMS TRACE BLVD , SUITE 104
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Directions to “INSIGHT MEDICAL DIAGNOSTICS ” Practice Location

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