Provider Demographics
NPI:1437253739
Name:MAHESRI, MURTAZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MURTAZA
Middle Name:
Last Name:MAHESRI
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:PO BOX 8101
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-0002
Mailing Address - Country:US
Mailing Address - Phone:936-436-1786
Mailing Address - Fax:936-435-1109
Practice Address - Street 1:130 MEDICAL CENTER PKWY STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4943
Practice Address - Country:US
Practice Address - Phone:936-436-1786
Practice Address - Fax:936-435-1109
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31718Medicare UPIN
81331NMedicare ID - Type Unspecified
TX81331NMedicare PIN