Provider Demographics
NPI:1063640001
Name:MOGHIMI, MICHAEL HOOMAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOOMAN
Last Name:MOGHIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 LOUISIANA ST
Mailing Address - Street 2:APT 3413
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9500
Mailing Address - Country:US
Mailing Address - Phone:214-476-6671
Mailing Address - Fax:
Practice Address - Street 1:4611 GUADALUPE ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-476-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034232207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery