Provider Demographics
NPI:1316219512
Name:IYAD K. RADWAN, MD., PA
Entity Type:Organization
Organization Name:IYAD K. RADWAN, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IYAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:RADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-645-4038
Mailing Address - Street 1:PO BOX 42453
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-2453
Mailing Address - Country:US
Mailing Address - Phone:832-645-4038
Mailing Address - Fax:832-675-9861
Practice Address - Street 1:411 PARK GROVE
Practice Address - Street 2:SUITE #620
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1576
Practice Address - Country:US
Practice Address - Phone:832-645-4038
Practice Address - Fax:832-675-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9481207RC0200X, 208D00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty