MEDICARE: NUSRAT B SOLEJA 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	J7680	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00271498	OTHER	TX	RR MEDICARE

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	8AD981	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1659356616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUSRAT B SOLEJA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 57668
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-7668
Country	:	US
Telephone Number	:	409-935-9800
Fax Number	:	409-935-9802

Provider Business Practice Location Address
First Line	:	6417 MEMORIAL DR
Second Line	:	STE A
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4058
Country	:	US
Telephone Number	:	409-935-9800
Fax Number	:	409-935-9802

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	03/18/2015

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