Provider Demographics
NPI:1467434563
Name:POONAWALA, ASHIQUEALI I (MD)
Entity Type:Individual
Prefix:
First Name:ASHIQUEALI
Middle Name:I
Last Name:POONAWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASHIQUEALI
Other - Middle Name:I
Other - Last Name:POONAWALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 73105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3105
Mailing Address - Country:US
Mailing Address - Phone:281-890-6800
Mailing Address - Fax:
Practice Address - Street 1:13311 HARGRAVE RD STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4310
Practice Address - Country:US
Practice Address - Phone:281-890-6800
Practice Address - Fax:281-890-6865
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043996001Medicaid
TXG54885Medicare UPIN
TX85700FMedicare PIN