Provider Demographics
NPI:1215017553
Name:WALI, ASHUTOSH (MD)
Entity Type:Individual
Prefix:
First Name:ASHUTOSH
Middle Name:
Last Name:WALI
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 1:1504 TAUB LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:713-873-2860
Mailing Address - Fax:713-873-2867
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-2860
Practice Address - Fax:713-873-2867
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9198207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L2333Medicare PIN
TX88H483Medicare PIN
G33224Medicare UPIN
TX050085798Medicare PIN