Provider Demographics
NPI:1093202764
Name:PEARLAND INTEGRATIVE FAMILY MEDICINE CLINIC
Entity Type:Organization
Organization Name:PEARLAND INTEGRATIVE FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHURSHEED
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGLAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-412-3251
Mailing Address - Street 1:11901 CEDAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1636
Mailing Address - Country:US
Mailing Address - Phone:832-512-9267
Mailing Address - Fax:
Practice Address - Street 1:3129 KINGSLEY DRIVE
Practice Address - Street 2:SUITE 440
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8258
Practice Address - Country:US
Practice Address - Phone:713-412-3251
Practice Address - Fax:832-426-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8609261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center