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General NPI Number Information
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NPI Number | 1386039360
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Entity Type | Organization
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Legal Business Name | MD GASTROENTEROLOGY ANESTHESIA SERVICES, PLLC
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 25230 KINSLAND BLVD STE 102
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City | KATY
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State | TX
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Zip | 77494-2097
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Country | US
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Telephone | 713-429-4828
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Fax | 713-429-4866
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Provider Business Mailing Address
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Address Line | 25230 KINSLAND BLVD STE 102
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City | KATY
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State | TX
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Zip | 77494-2097
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Country | US
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Telephone | 713-429-4828
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Fax | 713-429-4866
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Authorized Official
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Title or Position | SOLE MBR
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Name | RADHA TAMERISA
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Credential | MD
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Telephone | 713-540-8997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | L7210
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License Number State | TX
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