Provider Demographics
NPI:1689601619
Name:DALILI, DEAN HAMID (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:HAMID
Last Name:DALILI
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 1:23 WOOD MANOR PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2803
Mailing Address - Country:US
Mailing Address - Phone:504-577-1611
Mailing Address - Fax:772-794-0045
Practice Address - Street 1:23 WOOD MANOR PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2803
Practice Address - Country:US
Practice Address - Phone:504-577-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105525207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKR65N558Medicare ID - Type Unspecified
MDI50237Medicare UPIN