Healthcare Provider Details

I. General information

NPI: 1285083618
Provider Name (Legal Business Name): MALCOLM KHODADAD IRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MALCOLM IRANI

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 CORDES DR
SUGAR LAND TX
77479-1353
US

IV. Provider business mailing address

15555 CREEK BEND DR STE 200
SUGAR LAND TX
77478-4670
US

V. Phone/Fax

Practice location:
  • Phone: 832-707-5011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberT7602
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: