Healthcare Provider Details

I. General information

NPI: 1164787255
Provider Name (Legal Business Name): TABASSUM TAQI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 HUFFMEISTER RD STE 100
HOUSTON TX
77095-2865
US

IV. Provider business mailing address

PO BOX 207012
DALLAS TX
75320-7012
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 405-682-3303
  • Fax: 405-384-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-9508
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-42209
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ9055
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: