Healthcare Provider Details

I. General information

NPI: 1205134087
Provider Name (Legal Business Name): AVANT MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 SAN JACINTO ST SUITE 200
HOUSTON TX
77004-2708
US

IV. Provider business mailing address

5718 BELLAIRE BLVD
HOUSTON TX
77081-5506
US

V. Phone/Fax

Practice location:
  • Phone: 713-652-3145
  • Fax: 713-652-3146
Mailing address:
  • Phone: 713-785-2667
  • Fax: 713-785-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8699
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberK4259
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8699
License Number StateTX

VIII. Authorized Official

Name: SHAHID H. SYED
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 713-785-2667