Provider Demographics
NPI:1558361741
Name:ASLAM, AMBREEN (MD)
Entity Type:Individual
Prefix:
First Name:AMBREEN
Middle Name:
Last Name:ASLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20863 SWEETGLEN DR.
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6391
Mailing Address - Country:US
Mailing Address - Phone:832-237-8882
Mailing Address - Fax:832-237-8886
Practice Address - Street 1:11811 FALLBROOK DR.
Practice Address - Street 2:SUITE B-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3600
Practice Address - Country:US
Practice Address - Phone:832-237-8882
Practice Address - Fax:832-237-8886
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117728909Medicaid
TX117728908OtherMEDICAID TX HEALTH STEPS
F88659Medicare UPIN
TX117728909Medicaid