Provider Demographics
NPI:1801856240
Name:OOMMEN, BIJU (MD)
Entity type:Individual
Prefix:DR
First Name:BIJU
Middle Name:
Last Name:OOMMEN
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 650998
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0998
Mailing Address - Country:US
Mailing Address - Phone:281-389-0366
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 265
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5636
Practice Address - Country:US
Practice Address - Phone:281-389-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5863207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160354002Medicaid
8AD000OtherBLUE CROSS BLUE SHIELD
TX8CM153OtherBC/BS W/TRUMEN
TXP00413799OtherRR MEDICARE
8AD000OtherBLUE CROSS BLUE SHIELD
TX8F4836Medicare PIN