MEDICARE: NORTHWEST COLON & RECTAL SURGERY, P.A.

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	208C00000X	Colon & Rectal Surgery Physician	M1012	TX

General Provider Information

NPI Number	:	1740200203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST COLON & RECTAL SURGERY, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 540088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0088
Country	:	US
Telephone Number	:	713-850-1190
Fax Number	:	832-516-6184

Provider Business Practice Location Address
First Line	:	1125 CYPRESS STATION DR STE G-3
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3055
Country	:	US
Telephone Number	:	281-583-1300
Fax Number	:	832-516-6184

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	KHAWAJA AZIMUDDIN
Credential	:	M.D.
Telephone Number	:	281-583-1300

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/20/2025

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