Healthcare Provider Details

I. General information

NPI: 1548882038
Provider Name (Legal Business Name): HASEEB IKRAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 PINECROFT DR # N2101
SHENANDOAH TX
77380-3218
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1120
US

V. Phone/Fax

Practice location:
  • Phone: 713-897-2307
  • Fax:
Mailing address:
  • Phone: 409-772-2166
  • Fax: 409-772-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU5128
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU5128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: