Basic Information
| Provider Information | |||||||||
| NPI: | 1285612572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGRAWAL | ||||||||
| FirstName: | GIRISH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PEAKWOOD DR | ||||||||
| Address2: | SUITE 5E | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770902900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814405158 | ||||||||
| FaxNumber: | 2814408549 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 PEAKWOOD DR | ||||||||
| Address2: | SUITE 5E | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770902900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814405158 | ||||||||
| FaxNumber: | 2814408549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | L4209 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1537714-02 | 05 | TX | MEDICAID |