=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447372123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIC HEALTHCARE OF NORTHWEST HOUSTON PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 01/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12015 LOUETTA RD STE 100
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77070-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-664-2152
-----------------------------------------------------
Fax | 281-257-3514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11840 FM 1960 RD W
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-912-7044
-----------------------------------------------------
Fax | 832-912-7033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. KHOZEMA A PALANPURWALA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-357-5115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | J8338
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------