Basic Information
| Provider Information | |||||||||
| NPI: | 1619139847 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWENDY | ||||||||
| FirstName: | EMAD | ||||||||
| MiddleName: | BEHNAM BEBAWY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3066 E. COMMERCE ST. | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782201013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102337000 | ||||||||
| FaxNumber: | 2102776387 | ||||||||
| Practice Location | |||||||||
| Address1: | 8210 CALLAGHAN RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782304775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102337000 | ||||||||
| FaxNumber: | 2103489607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2008 | ||||||||
| LastUpdateDate: | 07/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P9390 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 12332267 | 05 | NM | MEDICAID | 572029YK73 | 01 | TX | MEDICARE | OTHER |