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General NPI Number Information
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NPI Number | 1750673901
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Entity Type | Individual
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Provider Name | IYAD K RADWAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 411 PARK GROVE SUITE #620
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City | KATY
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State | TX
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Zip | 77450-1576
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Country | US
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Telephone | 832-645-4038
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Fax | 832-675-9861
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Provider Business Mailing Address
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Address Line | P.O. BOX 42453
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City | HOUSTON
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State | TX
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Zip | 77242-2453
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Country | US
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Telephone | 832-620-3282
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Fax | 832-675-9861
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | N9481
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | N9481
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | N9481
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License Number State | TX
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