Provider Demographics
NPI:1285630244
Name:AIREWELE, GLADSTONE EHIAMETALOR (MD)
Entity Type:Individual
Prefix:MR
First Name:GLADSTONE
Middle Name:EHIAMETALOR
Last Name:AIREWELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:TWO GREENWAY PLAZA
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1187
Practice Address - Street 1:6701 FANNIN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-822-4890
Practice Address - Fax:832-825-1449
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK87062080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106153302Medicaid
TXH12450Medicare UPIN
TX106153302Medicaid