Provider Demographics
NPI:1225320849
Name:AI, DI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DI
Middle Name:
Last Name:AI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:AI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:MSB 2.136
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-5301
Mailing Address - Fax:713-500-0695
Practice Address - Street 1:5656 KELLEY STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-5261
Practice Address - Fax:713-566-5299
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89224207ZP0101X
PAMD465935207ZP0101X
TXU2424207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology