MEDICARE: XENON MEDICAL OF TEXAS 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	207L00000X	Anesthesiology Physician	AM00023	TX

General Provider Information

NPI Number	:	1588007215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XENON MEDICAL OF TEXAS PLLC

Provider Business Mailing Address
First Line	:	111 TOWN SQUARE PLAZA
Second Line	:	SUITE 420
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1724
Country	:	US
Telephone Number	:	917-397-1229
Fax Number	:	201-604-6561

Provider Business Practice Location Address
First Line	:	2500 WILCREST DR STE 300-3481
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2752
Country	:	US
Telephone Number	:	917-397-1229
Fax Number	:	201-604-6561

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAROON W CHAUDHRY
Credential	:	MD
Telephone Number	:	917-621-6854

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	05/12/2023

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