MEDICARE: KETTI AWAD MD

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	L6271	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01392339	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8FT466	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8EK654	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1740284710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETTI AWAD MD

Provider Business Mailing Address
First Line	:	6560 FANNIN ST
Second Line	:	SUITE 1130
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	713-363-8055
Fax Number	:	713-790-1060

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:	SUITE 1130
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	713-363-8055
Fax Number	:	713-790-1060

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/09/2019

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Directions to “ KETTI AWAD MD” Practice Location

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