Provider Demographics
NPI:1306847215
Name:KHETARPAL, UMANG (MD)
Entity Type:Individual
Prefix:
First Name:UMANG
Middle Name:
Last Name:KHETARPAL
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 1:1011 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:832-990-2700
Mailing Address - Fax:832-789-9400
Practice Address - Street 1:1800 W 26TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1450
Practice Address - Country:US
Practice Address - Phone:832-990-2700
Practice Address - Fax:832-789-9400
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-04-07
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TXL0330207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044807801Medicaid
TX8A1410OtherBLUE CROSS BLUE SHIELD
TX040015446OtherMEDICARE PIN (RAILROAD)
TX8A1410OtherBLUE CROSS BLUE SHIELD
TX8642K0Medicare PIN