Provider Demographics
NPI:1275823890
Name:POONAWALA, HUSEIN IMTIAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSEIN
Middle Name:IMTIAZ
Last Name:POONAWALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3051 CHURCHILL DR STE 116
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5900
Mailing Address - Country:US
Mailing Address - Phone:469-846-8346
Mailing Address - Fax:469-409-0001
Practice Address - Street 1:3051 CHURCHILL DR STE 116
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5900
Practice Address - Country:US
Practice Address - Phone:469-846-8346
Practice Address - Fax:469-409-0001
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2022-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010982272085R0202X
TXS21482085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology