Provider Demographics
NPI:1700045606
Name:ADIBI, MEHRAD (MD)
Entity Type:Individual
Prefix:
First Name:MEHRAD
Middle Name:
Last Name:ADIBI
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:MD ANDERSON BAY AREA
Mailing Address - Street 2:18100 SAINT JOHN DR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3631
Mailing Address - Country:US
Mailing Address - Phone:713-563-0670
Mailing Address - Fax:713-745-9816
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:713-563-0670
Practice Address - Fax:713-745-9816
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5503208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology