Provider Demographics
NPI:1639245905
Name:IMAM, TABASSUM ZAFFAR (MD)
Entity Type:Individual
Prefix:
First Name:TABASSUM
Middle Name:ZAFFAR
Last Name:IMAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TABASSUM
Other - Middle Name:ZAFFAR
Other - Last Name:ABDULLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2051 GREENHOUSE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7305
Mailing Address - Country:US
Mailing Address - Phone:281-492-7676
Mailing Address - Fax:281-492-8133
Practice Address - Street 1:2051 GREENHOUSE RD STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7305
Practice Address - Country:US
Practice Address - Phone:281-492-7676
Practice Address - Fax:281-492-8133
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4005208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102902Medicaid
ILH83205Medicare UPIN