Provider Demographics
NPI:1811049869
Name:HARISH KOOLWAL MD PA
Entity type:Organization
Organization Name:HARISH KOOLWAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOLWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-994-1177
Mailing Address - Street 1:214 W SAM HOUSTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5346
Mailing Address - Country:US
Mailing Address - Phone:956-994-1177
Mailing Address - Fax:956-283-0647
Practice Address - Street 1:214 W SAM HOUSTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5346
Practice Address - Country:US
Practice Address - Phone:956-994-1177
Practice Address - Fax:956-283-0647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH77771207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145516401Medicaid
TX00689ROtherBLUE CROSS GROUP
TXB12171Medicare UPIN
TX145516401Medicaid