Healthcare Provider Details

I. General information

NPI: 1275898603
Provider Name (Legal Business Name): WORLI MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 LAKE WOODLANDS DR
SPRING TX
77382-2565
US

IV. Provider business mailing address

70 W MATISSE MEADOW CT
THE WOODLANDS TX
77382-2795
US

V. Phone/Fax

Practice location:
  • Phone: 281-363-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMIR SHIRODKAR
Title or Position: MANAGING MEMBER
Credential:
Phone: 713-532-7311