MEDICARE: SOUTHEAST NOCTURNISTS LLC

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	207RI0200X	Infectious Disease Physician	N2144	TX

General Provider Information

NPI Number	:	1427395599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST NOCTURNISTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 57933
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-7933
Country	:	US
Telephone Number	:	832-554-1005
Fax Number	:	866-757-0081

Provider Business Practice Location Address
First Line	:	11914 ASTORIA BLVD STE 125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6073
Country	:	US
Telephone Number	:	832-554-1005
Fax Number	:	866-757-0081

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	HUMAIRA QURESHI
Credential	:
Telephone Number	:	832-554-1005

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	06/24/2024

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Directions to “SOUTHEAST NOCTURNISTS LLC ” Practice Location

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