Healthcare Provider Details

I. General information

NPI: 1730194150
Provider Name (Legal Business Name): ILYAS KAIZAR COLOMBOWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13325 HARGRAVE RD STE 280
HOUSTON TX
77070-4552
US

IV. Provider business mailing address

13325 HARGRAVE RD STE 280
HOUSTON TX
77070-4552
US

V. Phone/Fax

Practice location:
  • Phone: 832-478-5067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12748
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number12748
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberM13580
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberL8654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: