Provider Demographics
NPI:1740284710
Name:AWAD, KETTI (MD)
Entity type:Individual
Prefix:
First Name:KETTI
Middle Name:
Last Name:AWAD
Suffix:
Gender:F
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 ST
Mailing Address - Street 2:SUITE 1130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-363-8055
Mailing Address - Fax:713-790-1060
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-363-8055
Practice Address - Fax:713-790-1060
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FT466OtherBCBS
TXP01392339OtherRR MEDICARE
TX158313003Medicaid
TX158313002Medicaid
TX8EK654OtherBCBS
TX8FT466OtherBCBS
TX8J9015Medicare PIN
TXP01392339OtherRR MEDICARE
TX368797YMVQMedicare PIN