MEDICARE: INTERCONTINENTAL PSYCHIATRY 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	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q7955	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1861088346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERCONTINENTAL PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	10003 PALISADE LAKES DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-6648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6902 S PEEK RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1741
Country	:	US
Telephone Number	:	832-492-2169
Fax Number	:

Authorized Official
Title or Position	:	COORDINATOR
Name	:	HUMAIR MALIK
Credential	:
Telephone Number	:	281-978-4312

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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