MEDICARE: QAYYUM ENTERPRISES, LLC

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	246XC2903X	Vascular Specialist/Technologist Cardiovascular	00066104	TX

General Provider Information

NPI Number	:	1164681318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QAYYUM ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	10518 KIPP WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-2400
Country	:	US
Telephone Number	:	281-575-8414
Fax Number	:	281-575-1189

Provider Business Practice Location Address
First Line	:	10518 KIPP WAY
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77099-2400
Country	:	US
Telephone Number	:	281-575-8414
Fax Number	:	281-575-1189

Authorized Official
Title or Position	:	CARDIOVASCULAR TECH/ PARTNER
Name	:	MRS. MUJEEBUNNISA PARVEZ
Credential	:	CARDIOVASCULAR TECH
Telephone Number	:	281-575-8414

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	08/12/2008

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Directions to “QAYYUM ENTERPRISES, LLC ” Practice Location

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