=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215683032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ICARE MEDICAL IMAGING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2022
-----------------------------------------------------
Last Update Date | 03/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9898 BISSONNET STREET SUITE #150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-900-7313
-----------------------------------------------------
Fax | 832-476-3535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9898 BISSONNET STREET SUITE #150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-900-7313
-----------------------------------------------------
Fax | 832-476-3535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ATIF FAHIM MIRZA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-614-5323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------