Basic Information
| Provider Information | |||||||||
| NPI: | 1447372123 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRIC HEALTHCARE OF NORTHWEST HOUSTON PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | KHOZEMA PALANPURWALA MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11840 FM 1960 RD W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770653840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8329127044 | ||||||||
| FaxNumber: | 8329127033 | ||||||||
| Practice Location | |||||||||
| Address1: | 12015 LOUETTA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770701148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816642152 | ||||||||
| FaxNumber: | 2812573514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PALANPURWALA | ||||||||
| AuthorizedOfficialFirstName: | KHOZEMA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2813575115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | J8338 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 035826904 | 05 | TX | MEDICAID | 1134124779 | 01 | TX | NPI | OTHER | 1346554086 | 01 | NPI | OTHER | 1275835530 | 01 | NPI | OTHER | 1346247301 | 01 | TX | NPI | OTHER | 1922115534 | 01 | NPI | OTHER | 039452004 | 05 | TX | MEDICAID | 1508848995 | 01 | NPI | OTHER | 1841389897 | 01 | NPI | OTHER | 128256808 | 05 | TX | MEDICAID | 1295737286 | 01 | NPI | OTHER | 1780651133 | 01 | NPI | OTHER | 160185803 | 05 | TX | MEDICAID | 218384001 | 05 | TX | MEDICAID | 1841389897 | 01 | TX | NPI | OTHER | 194471202 | 05 | TX | MEDICAID | 1992772990 | 01 | NPI | OTHER | 130902308 | 05 | TX | MEDICAID | 1386611721 | 01 | NPI | OTHER |