Provider Demographics
NPI:1639286529
Name:BIJU OOMMEN, M.D., P.A.
Entity Type:Organization
Organization Name:BIJU OOMMEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:OOMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-389-0366
Mailing Address - Street 1:8307 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3905
Mailing Address - Country:US
Mailing Address - Phone:713-796-9955
Mailing Address - Fax:713-796-9779
Practice Address - Street 1:815 S VOSS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1031
Practice Address - Country:US
Practice Address - Phone:281-389-0366
Practice Address - Fax:281-596-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5863207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191391501Medicaid
TXDF9433OtherRR MEDICARE
TX0018PSOtherBLUE CROSS BLUE SHIELD
TXDF9433OtherRR MEDICARE
TX00X473Medicare PIN