MEDICARE: IMRAN SULTAN MAKNOJIA MD

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	390200000X	Student in an Organized Health Care Education/Training Program	BP10089096	TX
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1588254296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMRAN SULTAN MAKNOJIA MD

Provider Business Mailing Address
First Line	:	701 W 5TH ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79763-4206
Country	:	US
Telephone Number	:	432-703-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	12245 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2518
Country	:	US
Telephone Number	:	281-558-6700
Fax Number	:

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

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	06/21/2024

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