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General NPI Number Information
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NPI Number | 1417401258
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Entity Type | Organization
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Legal Business Name | UT PHYSICIANS
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 10623 BELLAIRE BLVD SUITE C280
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City | HOUSTON
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State | TX
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Zip | 77072-5242
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Country | US
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Telephone | 713-486-5900
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Fax | 713-486-5901
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Provider Business Mailing Address
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Address Line | 10623 BELLAIRE BLVD SUITE C280
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City | HOUSTON
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State | TX
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Zip | 77072-5242
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Country | US
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Telephone | 713-486-5900
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Fax | 713-486-5901
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. FAHAD KAMAL
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Credential | MBA,MS, CLSSGB
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Telephone | 713-486-5915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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