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General NPI Number Information
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NPI Number | 1205176369
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Entity Type | Organization
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Legal Business Name | GERANIUM MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 6201 BONHOMME RD SUITE # 290N-U
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City | HOUSTON
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State | TX
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Zip | 77036-4365
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Country | US
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Telephone | 281-888-4214
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Fax | 281-888-4391
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Provider Business Mailing Address
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Address Line | 6201 BONHOMME RD SUITE # 290N-U
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City | HOUSTON
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State | TX
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Zip | 77036-4365
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Country | US
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Telephone | 281-888-4214
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Fax | 281-888-4391
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Authorized Official
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Title or Position | CEO
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Name | DR. AMISHA S. CHHIPWADIA
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Credential | M.D.
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Telephone | 281-888-4214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P1978
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License Number State | TX
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