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General NPI Number Information
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NPI Number | 1225718919
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Entity Type | Individual
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Provider Name | KEROLLOS WANIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1515 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4000
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Country | US
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Telephone | 713-792-6161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4439
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City | HOUSTON
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State | TX
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Zip | 77210-4439
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Country | US
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Telephone | 713-792-2991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10083386
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | V4518
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License Number State | TX
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