Provider Demographics
NPI:1801004627
Name:MOHAMMED A. ISLAM M.D.P.A.
Entity Type:Organization
Organization Name:MOHAMMED A. ISLAM M.D.P.A.
Other - Org Name:GULF COAST CARDIOLOGY GRP. P.L.LC.
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:AMIRUL
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-963-0000
Mailing Address - Street 1:PO BOX 4575
Mailing Address - Street 2:MOHAMMED AMIRUL ISLAM, MD PA; MSC # 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4575
Mailing Address - Country:US
Mailing Address - Phone:409-963-0000
Mailing Address - Fax:409-963-1899
Practice Address - Street 1:3921 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2118
Practice Address - Country:US
Practice Address - Phone:409-963-0000
Practice Address - Fax:409-963-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163755501Medicaid
TX163755501Medicaid