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NPI Code Detail

MEDICARE: PREMSWARUP JOEL IMMARAJ M.D.

MEDICARE: PREMSWARUP JOEL IMMARAJ M.D.
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
1207P00000XEmergency Medicine PhysicianL4655TX
2207R00000XInternal Medicine PhysicianL4655TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356377915
Entity Type Code : Individual
Provider Name (Legal Business Name) : PREMSWARUP JOEL IMMARAJ M.D.
Provider Business Mailing Address
First Line : 5447 EMBERWOOD WAY
Second Line :
City : SUGAR LAND
State : TX
Zip : 77479-4273
Country : US
Telephone Number : 832-264-4028
Fax Number :
Provider Business Practice Location Address
First Line : 110 MEMORIAL HOSPITAL DR
Second Line :
City : HUNTSVILLE
State : TX
Zip : 77340-4940
Country : US
Telephone Number : 936-291-3411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 02/28/2020

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