Provider Demographics
NPI:1346230976
Name:DAIRYWALA, ISMAIL TAHERALI (MD)
Entity Type:Individual
Prefix:MR
First Name:ISMAIL
Middle Name:TAHERALI
Last Name:DAIRYWALA
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 1:16407 LAKEWOOD FIELD DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8789
Mailing Address - Country:US
Mailing Address - Phone:832-473-8854
Mailing Address - Fax:
Practice Address - Street 1:16407 LAKEWOOD FIELD DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8789
Practice Address - Country:US
Practice Address - Phone:832-473-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0114207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
809709Medicare ID - Type Unspecified
G34099Medicare UPIN