MEDICARE: MR. SORAB MINOD ITALIA DO

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	207Q00000X	Family Medicine Physician	L0829	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1386637767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SORAB MINOD ITALIA DO

Provider Business Mailing Address
First Line	:	12121 RICHMOND AVE
Second Line	:	STE 121
City	:	HOUSTON
State	:	TX
Zip	:	77082-2432
Country	:	US
Telephone Number	:	281-558-6700
Fax Number	:	281-558-1741

Provider Business Practice Location Address
First Line	:	12121 RICHMOND AVE
Second Line	:	STE 121
City	:	HOUSTON
State	:	TX
Zip	:	77082-2432
Country	:	US
Telephone Number	:	281-558-6700
Fax Number	:	281-558-1741

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	01/12/2010

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