Healthcare Provider Details

I. General information

NPI: 1558670935
Provider Name (Legal Business Name): I L GOLD, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SOUTHWEST FWY 1052
HOUSTON TX
77074-1802
US

IV. Provider business mailing address

7777 SOUTHWEST FWY 1052
HOUSTON TX
77074
US

V. Phone/Fax

Practice location:
  • Phone: 713-988-8776
  • Fax: 713-988-8662
Mailing address:
  • Phone: 713-988-8776
  • Fax: 713-988-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RITA FELAN
Title or Position: BILLING MANAGER
Credential:
Phone: 979-299-0091