Basic Information
| Provider Information | |||||||||
| NPI: | 1508815861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMSEIS | ||||||||
| FirstName: | ESSAM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 201088 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772161088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135005663 | ||||||||
| FaxNumber: | 7135005750 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 FANNIN ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323256516 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | N2124 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1571512 | 05 | LA | MEDICAID | 198299301 | 05 | TX | MEDICAID | 198299302 | 01 | CSHCN | OTHER | 8X7059 | 01 | TX | BCBSTX | OTHER | FTL42516 208000000X | 01 | TX | TEXAS LICENSE AND PRIMARY TAXONOMY | OTHER | FTL42516 208000000X | 01 | TX | TX LICENSE AND PRIMARY TAXONOMY | OTHER |