MEDICARE: EMMA CID M.D.

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	J2541	TX
2	207RC0000X	Cardiovascular Disease Physician	J2541	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851325799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA CID M.D.

Provider Business Mailing Address
First Line	:	2262 BANCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3706
Country	:	US
Telephone Number	:	713-208-4888
Fax Number	:	713-391-8425

Provider Business Practice Location Address
First Line	:	2262 BANCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3706
Country	:	US
Telephone Number	:	713-208-4888
Fax Number	:	713-391-8425

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/16/2012

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Directions to “ EMMA CID M.D.” Practice Location

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