MEDICARE: PEDIATRIC UROLOGY DPC PLLC

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	2088P0231X	Pediatric Urology Physician

General Provider Information

NPI Number	:	1366399685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC UROLOGY DPC PLLC

Provider Business Mailing Address
First Line	:	5318 WESLAYAN ST # 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1048
Country	:	US
Telephone Number	:	713-701-9451
Fax Number	:	713-804-7975

Provider Business Practice Location Address
First Line	:	4220 CARTWRIGHT RD STE 502
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5311
Country	:	US
Telephone Number	:	713-701-9451
Fax Number	:	713-804-7975

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA MITTAL
Credential	:	MD
Telephone Number	:	601-954-4989

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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