Provider Demographics
NPI:1770912545
Name:CHOWDHURY, MOHAMMAD IMTIAZ
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:IMTIAZ
Last Name:CHOWDHURY
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 1:711 W NOLANA AVE
Mailing Address - Street 2:SUITE 104G
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3078
Mailing Address - Country:US
Mailing Address - Phone:956-560-8783
Mailing Address - Fax:956-752-3190
Practice Address - Street 1:711 W NOLANA AVE
Practice Address - Street 2:SUITE 104G
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3078
Practice Address - Country:US
Practice Address - Phone:956-560-8783
Practice Address - Fax:956-752-3190
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015499163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice