Provider Demographics
NPI:1457349623
Name:TAM TAM, KIRAN BABU (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:BABU
Last Name:TAM TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1709 DRYDEN RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2400
Mailing Address - Country:US
Mailing Address - Phone:713-798-5511
Mailing Address - Fax:713-798-2701
Practice Address - Street 1:13215 DOTSON RD
Practice Address - Street 2:SUITE 360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4535
Practice Address - Country:US
Practice Address - Phone:832-828-3919
Practice Address - Fax:281-807-3170
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO41798207V00000X
MS20153207VM0101X
TXN8583207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01550039Medicaid
BT8267759OtherDEA
TXTXB131402Medicare PIN
H95617Medicare UPIN
C513418Medicare PIN