Provider Demographics
NPI:1457324972
Name:ISLAM, NADIM BIN (MD)
Entity Type:Individual
Prefix:
First Name:NADIM
Middle Name:BIN
Last Name:ISLAM
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 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:504 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:409-539-1111
Practice Address - Fax:409-788-8044
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0116207P00000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177265901Medicaid
TX177265906Medicaid
TX1457324972OtherTRICARE SOUTH
TX8P5092OtherBCBSTX PROV NO
TX1772659-02Medicaid
TX177265901Medicaid
TXP00285606Medicare PIN
TX177265906Medicaid
TX8L2030Medicare PIN
TX8G1643Medicare PIN
TXI06084Medicare UPIN