Provider Demographics
NPI:1548246168
Name:KHOSHNEVIS, GHOLAMREZA (MD)
Entity Type:Individual
Prefix:
First Name:GHOLAMREZA
Middle Name:
Last Name:KHOSHNEVIS
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 1:1140 WESTMONT DR STE 320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4368
Mailing Address - Country:US
Mailing Address - Phone:713-804-3278
Mailing Address - Fax:281-837-7443
Practice Address - Street 1:4002 GARTH RD STE 110
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3179
Practice Address - Country:US
Practice Address - Phone:713-804-3278
Practice Address - Fax:888-571-4434
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2228207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041135705Medicaid
TX041135701Medicaid
TXP01778057OtherRR MEDICARE
TX8GD673OtherBCBS
TXP01778057OtherRR MEDICARE
TXTXB124188Medicare PIN
TXG69376Medicare UPIN
TX82A548Medicare PIN