Physician Compare National (NPI:1013110733)

HEALTHCARE PROVIDER: IRFAN I WADIWALA D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1013110733
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2365543667
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081118000349
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WADIWALA
	Individual professional last name
Provider First Name	IRFAN
	Individual professional first name
Provider Middle Name	I
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WESTERN UNIVERSITY OF HEALTH SCIENCES COLLEGE OF DENTAL MED
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	13323 DOTSON RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 210
	Group Practice or individual's line 2 address
City	HOUSTON
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	770704538
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450844
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOUSTON METHODIST WILLOWBROOK HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	670075
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST LUKE'S HOSPITAL AT THE VINTAGE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450068
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MEMORIAL HERMANN - TEXAS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	450803
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	DOCTORS HOSPITAL TIDWELL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y