MEDICARE: ROUND TABLE SPECIALIST GROUP, 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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1497152268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUND TABLE SPECIALIST GROUP, PLLC

Provider Business Mailing Address
First Line	:	8910 HIGHWAY 6 S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6339
Country	:	US
Telephone Number	:	832-429-8027
Fax Number	:

Provider Business Practice Location Address
First Line	:	8910 HIGHWAY 6 S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6339
Country	:	US
Telephone Number	:	832-429-8027
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HASHIBUL HANNAN
Credential	:	M.D.
Telephone Number	:	832-429-8027

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	11/22/2014

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