Provider Demographics
NPI:1144614322
Name:INFECTIOUS DISEASES CLINIC AT CLEAR LAKE SPECIALTIES PLLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES CLINIC AT CLEAR LAKE SPECIALTIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-724-1860
Mailing Address - Street 1:PO BOX 58688
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8688
Mailing Address - Country:US
Mailing Address - Phone:281-724-8336
Mailing Address - Fax:281-336-1619
Practice Address - Street 1:600 N KOBAYASHI STE 308
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8336
Practice Address - Fax:281-336-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P9P4OtherBCBS
TX347016301Medicaid
TX00P9P4OtherBCBS