Healthcare Provider Details

I. General information

NPI: 1194996702
Provider Name (Legal Business Name): BASHIR FARIS AL KADDOUMI M.B, B.S, M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18220 STATE HIGHWAY 249 SUITE 205
HOUSTON TX
77070-4347
US

IV. Provider business mailing address

PO BOX 733490
DALLAS TX
75373-3490
US

V. Phone/Fax

Practice location:
  • Phone: 832-241-2001
  • Fax: 281-547-7464
Mailing address:
  • Phone: 832-241-2001
  • Fax: 281-547-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberP1959
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301099922
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberP1959
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberP1959
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: