Provider Demographics
NPI:1225718919
Name:WANIS, KEROLLOS NASHAT (MD)
Entity Type:Individual
Prefix:
First Name:KEROLLOS
Middle Name:NASHAT
Last Name:WANIS
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 1:1699 HERMANN DR
Mailing Address - Street 2:APT 2103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESSLER ST DEPARTMENT OF BREAST SURGICAL ONCOLOGY
Practice Address - Street 2:UNIT 1434
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-745-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10083386390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program