Basic Information
| Provider Information | |||||||||
| NPI: | 1255587879 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WIFUMAM PA | ||||||||
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| OtherOrganizationName: | GENERAL LAPAROSCOPIC AND BARIATRIC SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 690786 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772690786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816536544 | ||||||||
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| 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: | 08/14/2008 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | WADIWALA | ||||||||
| AuthorizedOfficialFirstName: | IRFAN | ||||||||
| AuthorizedOfficialMiddleName: | IBRAHIM | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2816536544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N0535 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.