Provider Demographics
NPI:1477693711
Name:FAHNBULLEH INFECTIOUS DISEASE CONSULTANTS P A
Entity Type:Organization
Organization Name:FAHNBULLEH INFECTIOUS DISEASE CONSULTANTS P A
Other - Org Name:HOUSTON COMMUNITY ID ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROP.
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:FAHNBULLEH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-979-0251
Mailing Address - Street 1:PO BOX 941478
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-8478
Mailing Address - Country:US
Mailing Address - Phone:713-979-0251
Mailing Address - Fax:713-987-0404
Practice Address - Street 1:9601 KATY FREEWAY
Practice Address - Street 2:STE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1300
Practice Address - Country:US
Practice Address - Phone:713-979-0251
Practice Address - Fax:713-987-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169653601Medicaid
TXG94580Medicare UPIN
TX00726WMedicare ID - Type Unspecified