Healthcare Provider Details

I. General information

NPI: 1548642127
Provider Name (Legal Business Name): QASIM MAHBOOB M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date: 01/25/2016
Reactivation Date: 05/10/2016

III. Provider practice location address

920 FROSTWOOD DR STE 2.300
HOUSTON TX
77024-2314
US

IV. Provider business mailing address

4201 ST. ANTOINE UHC-2E
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 713-338-5519
  • Fax:
Mailing address:
  • Phone: 313-745-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-45289
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU3287
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU3287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: