Healthcare Provider Details

I. General information

NPI: 1104317726
Provider Name (Legal Business Name): SYED KALIMULLAH SOHAIB QADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE STE 850
FRESNO CA
93720-3309
US

IV. Provider business mailing address

6431 FANNIN ST STE JJL 310
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5672
  • Fax:
Mailing address:
  • Phone: 832-325-7080
  • Fax: 713-512-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA176066
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA176066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: