Basic Information
| Provider Information | |||||||||
| NPI: | 1639286529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIJU OOMMEN, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8307 KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137969955 | ||||||||
| FaxNumber: | 7137969779 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 S VOSS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770571031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813890366 | ||||||||
| FaxNumber: | 2815964357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 06/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | OOMMEN | ||||||||
| AuthorizedOfficialFirstName: | BIJU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2813890366 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | L5863 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 191391501 | 05 | TX | MEDICAID | DF9433 | 01 | TX | RR MEDICARE | OTHER | 0018PS | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |