Healthcare Provider Details

I. General information

NPI: 1275988651
Provider Name (Legal Business Name): ASTRID GROULS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ # MS 680
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

7200 CAMBRIDGE ST
HOUSTON TX
77030-4202
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-2298
  • Fax:
Mailing address:
  • Phone: 713-798-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS4772
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS4772
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberS4772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: