Provider Demographics
NPI:1013110733
Name:WADIWALA, IRFAN I (DO)
Entity Type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:I
Last Name:WADIWALA
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:PO BOX 690786
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-0786
Mailing Address - Country:US
Mailing Address - Phone:281-653-6544
Mailing Address - Fax:281-807-9702
Practice Address - Street 1:13323 DOTSON RD STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4538
Practice Address - Country:US
Practice Address - Phone:281-653-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0535208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery