MEDICARE: MUMTAZ SULEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	L6190	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	L6190	TX
3	2084P0800X	Psychiatry Physician	01051280A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023017431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUMTAZ SULEMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 SPACE PARK DR
Second Line	:	STE 108
City	:	HOUSTON
State	:	TX
Zip	:	77058-3600
Country	:	US
Telephone Number	:	281-316-6501
Fax Number	:	281-339-7180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/26/2025

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Directions to “ MUMTAZ SULEMAN MD” Practice Location

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