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General NPI Number Information
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NPI Number | 1043426075
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Entity Type | Organization
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Legal Business Name | HOUSTON HEART CLINIC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 6624 FANNIN ST STE. 1590
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City | HOUSTON
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State | TX
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Zip | 77030-2312
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Country | US
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Telephone | 713-759-9901
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Fax | 281-540-3333
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Provider Business Mailing Address
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Address Line | 6624 FANNIN ST STE. 1590
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City | HOUSTON
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State | TX
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Zip | 77030-2312
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Country | US
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Telephone | 713-759-9901
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Fax | 281-540-3333
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Authorized Official
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Title or Position | PRESIDENT
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Name | IMTIHAN M JAWDAT
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Credential | MD
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Telephone | 713-759-9901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G9602
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G9602
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License Number State | TX
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