Provider Demographics
NPI:1831456730
Name:NILESH BAVISHI
Entity Type:Organization
Organization Name:NILESH BAVISHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-3639
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 554
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-777-3639
Mailing Address - Fax:713-777-3638
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 554
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-777-3639
Practice Address - Fax:713-777-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609814599OtherNPI
0035BKMedicare PIN
TX131155704Medicaid
E63923Medicare UPIN