MEDICARE: WASAE SEYED TABIBI 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	207RN0300X	Nephrology Physician	J1576	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	49384	OTHER	AMERIGROUP
3	81093X	OTHER	BCBS

General Provider Information

NPI Number	:	1255336012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WASAE SEYED TABIBI MD

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 1730
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2735
Country	:	US
Telephone Number	:	713-795-5511
Fax Number	:	713-795-4627

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1730
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2735
Country	:	US
Telephone Number	:	713-795-5511
Fax Number	:	713-795-4627

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/21/2022

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