Provider Demographics
NPI:1275759383
Name:MAKWANA, AMBALAL D (LSA)
Entity Type:Individual
Prefix:
First Name:AMBALAL
Middle Name:D
Last Name:MAKWANA
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 RYANEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5077
Mailing Address - Country:US
Mailing Address - Phone:281-225-4013
Mailing Address - Fax:281-225-4013
Practice Address - Street 1:13010 RYANEAGLES DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-5077
Practice Address - Country:US
Practice Address - Phone:281-225-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA0181171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLSA0181OtherLISCENCED SURGICAL ASSIST