MEDICARE: DR. MIR ALI SADAT 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	207R00000X	Internal Medicine Physician	35.134290	OH
2	207R00000X	Internal Medicine Physician	R7871	TX

General Provider Information

NPI Number	:	1508244179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIR ALI SADAT M.D.

Provider Business Mailing Address
First Line	:	320 KINGWOOD EXECUTIVE DR STE B
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2769
Country	:	US
Telephone Number	:	281-456-2540
Fax Number	:	281-456-2541

Provider Business Practice Location Address
First Line	:	320 KINGWOOD EXECUTIVE DR STE B
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2769
Country	:	US
Telephone Number	:	713-591-0377
Fax Number	:	281-564-2541

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

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	04/14/2025

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