=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619429792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMAD H. ASHAM, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2016
-----------------------------------------------------
Last Update Date | 10/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 FANNIN ST SUITE 1810
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-964-4001
-----------------------------------------------------
Fax | 832-831-2463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 300425
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77230-0425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-964-4001
-----------------------------------------------------
Fax | 832-831-2463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON
-----------------------------------------------------
Name | DR. EMAD HAKEEM ASHAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 832-964-4001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | N1536
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------