MEDICARE: DI SU 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	207P00000X	Emergency Medicine Physician	233715	NY
2	207P00000X	Emergency Medicine Physician	M2134	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8W7219	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1497772099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DI SU M.D.

Provider Business Mailing Address
First Line	:	2222 MARONEAL ST UNIT 444
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9774 KATY FWY STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-6240
Country	:	US
Telephone Number	:	832-358-0200
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/15/2023

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Directions to “ DI SU M.D.” Practice Location

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