Healthcare Provider Details

I. General information

NPI: 1578318911
Provider Name (Legal Business Name): KHADIJAH EID MBBS , MSCS, SB-URO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 21003012
HOUSTON TX
77030-2761
US

IV. Provider business mailing address

535 BARNHILL DR
INDIANAPOLIS IN
46202-5116
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-6455
  • Fax: 713-790-5866
Mailing address:
  • Phone: 317-278-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number1167486F0
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: