Healthcare Provider Details

I. General information

NPI: 1699979252
Provider Name (Legal Business Name): LABIB MIKRAM GHULMIYYAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0462
US

IV. Provider business mailing address

2350 BAGBY ST APT 5310
HOUSTON TX
77006-1784
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-4194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine
License NumberTP1-0024578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: