Provider Demographics
NPI:1467059857
Name:ADVANCED INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KUTAYBA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAFADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-666-8753
Mailing Address - Street 1:13656 BRETON RIDGE ST # AH
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6081
Mailing Address - Country:US
Mailing Address - Phone:248-525-9108
Mailing Address - Fax:832-308-1272
Practice Address - Street 1:13656 BRETON RIDGE ST # AH
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6081
Practice Address - Country:US
Practice Address - Phone:281-205-5100
Practice Address - Fax:832-308-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty