Provider Demographics
NPI:1770523276
Name:KHOWAJA, MAZHAR
Entity type:Individual
Prefix:DR
First Name:MAZHAR
Middle Name:
Last Name:KHOWAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 STELLA LINK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5639
Mailing Address - Country:US
Mailing Address - Phone:713-592-9292
Mailing Address - Fax:713-592-9296
Practice Address - Street 1:10777 STELLA LINK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5639
Practice Address - Country:US
Practice Address - Phone:713-592-9292
Practice Address - Fax:713-592-9296
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010691182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI470011410OtherMEDICAID
MI0823651OtherBCBS
MI0P06530001Medicare ID - Type Unspecified
MIF86368Medicare UPIN
MI0M24700017Medicare ID - Type Unspecified
MIP00308342Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MI0P27820001Medicare ID - Type Unspecified