Provider Demographics
NPI:1174815062
Name:TASNEEM, NUZHATH (MD)
Entity Type:Individual
Prefix:
First Name:NUZHATH
Middle Name:
Last Name:TASNEEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18518 EACH ELM WAY
Mailing Address - Street 2:BARKERS TRAIL
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7686
Mailing Address - Country:US
Mailing Address - Phone:214-886-6702
Mailing Address - Fax:
Practice Address - Street 1:1102 N PINE RD
Practice Address - Street 2:STE C
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465-4804
Practice Address - Country:US
Practice Address - Phone:318-495-3880
Practice Address - Fax:318-495-3882
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.207415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program