Provider Demographics
NPI:1437457686
Name:NORTHWEST CARDIOVASCULAR CLINIC, PA
Entity Type:Organization
Organization Name:NORTHWEST CARDIOVASCULAR CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAIRYWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-473-8854
Mailing Address - Street 1:16407 LAKEWOOD FIELD DR
Mailing Address - Street 2:LAKEWOOD FIELD DRIVE
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0114261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty