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General NPI Number Information
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NPI Number | 1992074710
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Entity Type | Organization
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Legal Business Name | IMD HEALTHCARE AND IMAGING
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 13107 W LAKE HOUSTON PKWY
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City | HOUSTON
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State | TX
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Zip | 77044-5391
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Country | US
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Telephone | 281-360-3269
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Fax |
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Provider Business Mailing Address
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Address Line | 7403 KINGS RIVER CT
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City | KINGWOOD
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State | TX
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Zip | 77346-1475
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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 | CEO AND PRESIDENT
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Name | DR. HUMARA S GULL
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Credential | M.D.
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Telephone | 281-360-3269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | K1456
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | K1456
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | K1456
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License Number State | TX
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