Provider Demographics
NPI:1992026561
Name:BADREI, MAHYAR (DO)
Entity Type:Individual
Prefix:DR
First Name:MAHYAR
Middle Name:
Last Name:BADREI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N LOOP WEST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3550
Mailing Address - Country:US
Mailing Address - Phone:281-702-6134
Mailing Address - Fax:713-867-2076
Practice Address - Street 1:1635 NORTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1532
Practice Address - Country:US
Practice Address - Phone:713-867-2066
Practice Address - Fax:713-867-2076
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4846207Q00000X, 208M00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care