MEDICARE: WOMANS CLINIC 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1609211077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMANS CLINIC PLLC

Provider Business Mailing Address
First Line	:	2424 W HOLCOMBE BLVD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1933
Country	:	US
Telephone Number	:	832-804-8119
Fax Number	:	832-804-8120

Provider Business Practice Location Address
First Line	:	2424 W HOLCOMBE BLVD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1933
Country	:	US
Telephone Number	:	832-804-8119
Fax Number	:	832-804-8120

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MAHESH K SHETTY
Credential	:	MD
Telephone Number	:	832-804-8119

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	10/16/2015

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