Provider Demographics
NPI:1518215011
Name:ALTAKI, SOUBHI (MD,)
Entity type:Individual
Prefix:
First Name:SOUBHI
Middle Name:
Last Name:ALTAKI
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:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:346-739-8061
Mailing Address - Fax:346-200-3256
Practice Address - Street 1:4615 SOUTHWEST FWY STE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7108
Practice Address - Country:US
Practice Address - Phone:346-739-8061
Practice Address - Fax:346-200-3256
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7133207R00000X, 208M00000X, 207RN0300X, 207RN0300X
LA334695207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist