MEDICARE: IMAD M RIAZUDDIN 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	207L00000X	Anesthesiology Physician	U2619	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	U2619	TX

General Provider Information

NPI Number	:	1255891644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMAD M RIAZUDDIN MD

Provider Business Mailing Address
First Line	:	PO BOX 4439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4439
Country	:	US
Telephone Number	:	713-792-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 FANNIN ST STE JJL 310
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-5154
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/09/2026

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Directions to “ IMAD M RIAZUDDIN MD” Practice Location

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