Basic Information
| Provider Information | |||||||||
| NPI: | 1821230780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABIDI | ||||||||
| FirstName: | WASIF | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALI | ||||||||
| OtherFirstName: | WASIF | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7200 CAMBRIDGE ST | ||||||||
| Address2: | SUITE 10C (CARE OF SHELINA VELANI) | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137980950 | ||||||||
| FaxNumber: | 7137980951 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 CAMBRIDGE ST | ||||||||
| Address2: | SUITE 10C | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137980950 | ||||||||
| FaxNumber: | 7137980951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Q9930 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 50225 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 390200000X | MT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | Q9930 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.