Provider Demographics
NPI:1760409478
Name:DR MUBARAK KHAWAJA PA
Entity Type:Organization
Organization Name:DR MUBARAK KHAWAJA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUBARAK
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-599-8070
Mailing Address - Street 1:707 S FRY RD
Mailing Address - Street 2:SUITE# 375
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2256
Mailing Address - Country:US
Mailing Address - Phone:281-599-8070
Mailing Address - Fax:281-599-8805
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:SUITE# 375
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-599-8070
Practice Address - Fax:281-599-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3277261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty