Provider Demographics
NPI:1508815861
Name:IMSEIS, ESSAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:ESSAM
Middle Name:M
Last Name:IMSEIS
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 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-5663
Mailing Address - Fax:713-500-5750
Practice Address - Street 1:6410 FANNIN ST STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3005
Practice Address - Country:US
Practice Address - Phone:832-325-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN21242080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1571512Medicaid
TX198299301Medicaid
198299302OtherCSHCN
TX8X7059OtherBCBSTX
TXFTL42516 208000000XOtherTEXAS LICENSE AND PRIMARY TAXONOMY
TXFTL42516 208000000XOtherTX LICENSE AND PRIMARY TAXONOMY
LA1571512Medicaid
TX8L6105Medicare PIN
I19058Medicare UPIN