Provider Demographics
NPI:1982869293
Name:ILYAS, MAHWISH
Entity Type:Individual
Prefix:
First Name:MAHWISH
Middle Name:
Last Name:ILYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4894 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4421
Mailing Address - Country:US
Mailing Address - Phone:832-937-5904
Mailing Address - Fax:888-639-5102
Practice Address - Street 1:4894 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4421
Practice Address - Country:US
Practice Address - Phone:832-937-5904
Practice Address - Fax:888-639-5102
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27576207R00000X
TXR9503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV27576OtherWV BOARD OF MEDICINE
CTFL2899067OtherDEA