MEDICARE: OCEANSIDE INTERNAL MEDICINE 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1619326287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANSIDE INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	4300 BAY AREA BLVD APT 212
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-1118
Country	:	US
Telephone Number	:	281-993-7208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 SPACE PARK DR STE 190
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-6305
Country	:	US
Telephone Number	:	281-993-7208
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / MANAGER
Name	:	KHURSHID KHAN MUHAMMAD
Credential	:	M.D.
Telephone Number	:	281-993-7208

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	06/06/2016

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