Provider Demographics
NPI:1710986294
Name:PERACHA, WASEEM (MD)
Entity Type:Individual
Prefix:
First Name:WASEEM
Middle Name:
Last Name:PERACHA
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 1:11152 WESTHEIMER RD
Mailing Address - Street 2:702
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3208
Mailing Address - Country:US
Mailing Address - Phone:281-558-8260
Mailing Address - Fax:281-531-8087
Practice Address - Street 1:12051 WESTPARK DR
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5556
Practice Address - Country:US
Practice Address - Phone:281-558-8260
Practice Address - Fax:281-531-8087
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2014-03-26
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXL0902207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030181403Medicaid
TX8H8370OtherBCBS
TX162944602Medicaid
TX390343OtherWELLCARE
TX86872ZOtherBCBS HMO
TXDA1849OtherRAILROAD MEDICARE
TX10011273OtherAMERIGROUP
TX162944602Medicaid
TX10011273OtherAMERIGROUP