Provider Demographics
NPI:1750673901
Name:RADWAN, IYAD K (MD)
Entity Type:Individual
Prefix:DR
First Name:IYAD
Middle Name:K
Last Name:RADWAN
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:P.O. BOX 42453
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-2453
Mailing Address - Country:US
Mailing Address - Phone:832-620-3282
Mailing Address - Fax:832-675-9861
Practice Address - Street 1:411 PARK GROVE
Practice Address - Street 2:SUITE #620
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1576
Practice Address - Country:US
Practice Address - Phone:832-645-4038
Practice Address - Fax:832-675-9861
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9481208D00000X, 208G00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine