MEDICARE: ITAI RONEN 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
1	207V00000X	Obstetrics & Gynecology Physician	A157805	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207V00000X	Obstetrics & Gynecology Physician	T2257	TX

General Provider Information

NPI Number	:	1376994905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITAI RONEN M.D.

Provider Business Mailing Address
First Line	:	950 THREADNEEDLE ST
Second Line	:	STE 282
City	:	HOUSTON
State	:	TX
Zip	:	77079-2925
Country	:	US
Telephone Number	:	713-464-4444
Fax Number	:	713-465-9718

Provider Business Practice Location Address
First Line	:	950 THREADNEEDLE ST
Second Line	:	STE 282
City	:	HOUSTON
State	:	TX
Zip	:	77079-2925
Country	:	US
Telephone Number	:	713-464-4444
Fax Number	:	713-465-9718

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	08/15/2022

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Directions to “ ITAI RONEN M.D.” Practice Location

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