Basic Information
| Provider Information | |||||||||
| NPI: | 1013110733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADIWALA | ||||||||
| FirstName: | IRFAN | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 690786 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772690786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816536544 | ||||||||
| FaxNumber: | 2818079702 | ||||||||
| Practice Location | |||||||||
| Address1: | 13323 DOTSON RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770704538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816536544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N0535 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.