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General NPI Number Information
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NPI Number | 1396185898
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Entity Type | Organization
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Legal Business Name | ANDOVER PARTNERS LLC
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 10214 HUNTINGTON VIEW DR
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City | HOUSTON
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State | TX
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Zip | 77099-3037
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Country | US
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Telephone | 515-528-5176
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Fax |
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Provider Business Mailing Address
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Address Line | 10214 HUNTINGTON VIEW DR
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City | HOUSTON
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State | TX
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Zip | 77099-3037
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MIRZA N BAIG
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Credential | MD
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Telephone | 515-528-5176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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