Provider Demographics
NPI:1164495339
Name:NATHANI, IMRAN SATTAR (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:SATTAR
Last Name:NATHANI
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 1:27721 TOMBALL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6561
Mailing Address - Country:US
Mailing Address - Phone:281-351-6800
Mailing Address - Fax:281-205-7739
Practice Address - Street 1:27721 TOMBALL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6561
Practice Address - Country:US
Practice Address - Phone:281-351-6800
Practice Address - Fax:281-205-7739
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG42024Medicare UPIN
TX8085B1Medicare PIN