Healthcare Provider Details

I. General information

NPI: 1316348501
Provider Name (Legal Business Name): M&M CLINICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10021 MAIN ST B3
HOUSTON TX
77025-5224
US

IV. Provider business mailing address

10021 MAIN ST SUITE B3
HOUSTON TX
77025-5224
US

V. Phone/Fax

Practice location:
  • Phone: 713-369-1969
  • Fax:
Mailing address:
  • Phone: 713-369-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP6037
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberP6037
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberP3036
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberP6037
License Number StateTX

VIII. Authorized Official

Name: REHAN MEMON
Title or Position: OWNER
Credential: MD
Phone: 713-369-1969