MEDICARE: DERMATOLOGY MANAGEMENT SERVICES 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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1992342653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY MANAGEMENT SERVICES PLLC

Provider Business Mailing Address
First Line	:	9225 KATY FWY STE 404
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1531
Country	:	US
Telephone Number	:	832-572-5533
Fax Number	:	832-975-0336

Provider Business Practice Location Address
First Line	:	9225 KATY FWY STE 404
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1531
Country	:	US
Telephone Number	:	832-572-5533
Fax Number	:	832-975-0336

Authorized Official
Title or Position	:	OWNER
Name	:	TAREK FAKHOURI
Credential	:	MD
Telephone Number	:	832-308-3470

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	01/06/2023

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