Provider Demographics
NPI:1689636565
Name:BHURIWALA, SHUJAUDDIN
Entity Type:Individual
Prefix:DR
First Name:SHUJAUDDIN
Middle Name:
Last Name:BHURIWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27721 TOMBALL PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6411
Mailing Address - Country:US
Mailing Address - Phone:281-357-1300
Mailing Address - Fax:281-357-1309
Practice Address - Street 1:27721 TOMBALL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6411
Practice Address - Country:US
Practice Address - Phone:281-357-1300
Practice Address - Fax:281-357-1309
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8009174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142418601Medicaid
TX8528M0OtherMEDICARE ID
TX142418601Medicaid