MEDICARE: INA THEODORA DU MD

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	207L00000X	Anesthesiology Physician	344527	LA

General Provider Information

NPI Number	:	1922635630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INA THEODORA DU MD

Provider Business Mailing Address
First Line	:	1885 EL PASEO ST APT 629
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3046
Country	:	US
Telephone Number	:	860-804-6011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1885 EL PASEO ST APT 629
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3046
Country	:	US
Telephone Number	:	860-804-6011
Fax Number	:

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

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	07/18/2025

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