Provider Demographics
NPI:1710189097
Name:IRANMANESH, HAMIDREZA (MD)
Entity Type:Individual
Prefix:
First Name:HAMIDREZA
Middle Name:
Last Name:IRANMANESH
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 1:2601 W LAKE HOUSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5222
Mailing Address - Country:US
Mailing Address - Phone:281-360-7502
Mailing Address - Fax:281-420-2953
Practice Address - Street 1:2601 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5222
Practice Address - Country:US
Practice Address - Phone:281-360-7502
Practice Address - Fax:281-360-0587
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3749207Q00000X, 208M00000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program