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8121 Broadway St Ste 103 Houston TX 77061-1341 | |
(713) 640-2273 | |
(713) 640-2276 |
Full Name | |
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Speciality | Family Medicine |
Location | 8121 Broadway St Ste 103, Houston, Texas |
Authorized Official Name and Position | Mustafa Chagani (CEO) |
Authorized Official Contact | 4696843227 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8121 Broadway St Ste 103 Houston TX 77061-1341 Ph: (713) 640-2273 | 8121 Broadway St Ste 103 Houston TX 77061-1341 Ph: (713) 640-2273 |
NPI Number | 1194263897 |
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Provider Enumeration Date | 02/02/2017 |
Last Update Date | 02/10/2021 |
Medicare PECOS PAC ID | 7113219114 |
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Medicare Enrollment ID | O20160712002497 |
Identifier | Type | State | Issuer |
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1194263897 | NPI | - | NPPES |
Provider Name | Asifa Ijaz |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689708729 PECOS PAC ID: 6204002009 Enrollment ID: I20111228000679 |
Provider Name | Alondra G Gutierrez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457645806 PECOS PAC ID: 9931327301 Enrollment ID: I20141208000582 |
Provider Name | Llewellyn B Canio |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1720371453 PECOS PAC ID: 2062731425 Enrollment ID: I20150506001247 |
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