Healthcare Provider Details

I. General information

NPI: 1134598345
Provider Name (Legal Business Name): OMKAR DAVE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 GEMINI ST
HOUSTON TX
77058-2705
US

IV. Provider business mailing address

1045 GEMINI ST
HOUSTON TX
77058-2705
US

V. Phone/Fax

Practice location:
  • Phone: 281-335-1111
  • Fax: 281-286-2950
Mailing address:
  • Phone: 281-335-1111
  • Fax: 281-286-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberQ3662
License Number StateTX

VIII. Authorized Official

Name: OMKAR DAVE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 832-643-4251