Provider Demographics
NPI:1295728525
Name:MUKHOPADHYAY, ARUN KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ARUN
Middle Name:KUMAR
Last Name:MUKHOPADHYAY
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 1:11914 ASTORIA BLVD
Mailing Address - Street 2:STE 580
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6064
Mailing Address - Country:US
Mailing Address - Phone:281-424-1253
Mailing Address - Fax:281-481-1205
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:STE 580
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:281-424-1253
Practice Address - Fax:281-481-1205
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE 1909174400000X
TXE1909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE1909OtherLICENSE
TX76-0005931OtherTAX IDENTIFICATION
TX034738701Medicaid
TX76-0005931OtherTAX IDENTIFICATION