Provider Demographics
NPI:1619326287
Name:OCEANSIDE INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:OCEANSIDE INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KHURSHID
Authorized Official - Middle Name:KHAN
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-993-7208
Mailing Address - Street 1:4300 BAY AREA BLVD APT 212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1118
Mailing Address - Country:US
Mailing Address - Phone:281-993-7208
Mailing Address - Fax:
Practice Address - Street 1:2045 SPACE PARK DR STE 190
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-6305
Practice Address - Country:US
Practice Address - Phone:281-993-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty