Provider Demographics
NPI:1295055507
Name:NAKAWAH, MOHAMMAD OBADAH (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:OBADAH
Last Name:NAKAWAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN STREET
Mailing Address - Street 2:SUITE 802
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3333
Mailing Address - Fax:713-790-5079
Practice Address - Street 1:6560 FANNIN STREET
Practice Address - Street 2:SUITE 802
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3333
Practice Address - Fax:713-790-5079
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ79342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370383701Medicaid