MEDICARE: MAI MEDICAL

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	:	1972205656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI MEDICAL

Provider Business Mailing Address
First Line	:	4807 SUGAR GROVE BLVD STE 302
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-2654
Country	:	US
Telephone Number	:	713-999-2860
Fax Number	:	713-999-2699

Provider Business Practice Location Address
First Line	:	4807 SUGAR GROVE BLVD STE 302
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-2654
Country	:	US
Telephone Number	:	713-999-2860
Fax Number	:	713-999-2689

Authorized Official
Title or Position	:	MANAGER
Name	:	MONICA TREVINO
Credential	:
Telephone Number	:	832-604-9944

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	12/09/2025

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