Basic Information
| Provider Information | |||||||||
| NPI: | 1861541922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVE | ||||||||
| FirstName: | AMISH | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SUITE 1901 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134411100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SUITE 1901 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134411100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 10/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N5005 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A87687 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N5005 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | N5005 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 211285601 | 05 | TX | MEDICAID | 211285602 | 05 | TX | MEDICAID | 8CG506 | 01 | TX | BCBS | OTHER | 211285609 | 05 | TX | MEDICAID | 1861541922 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 211285603 | 05 | TX | MEDICAID | P00849863 | 01 | TX | MEDICARE RAILROAD | OTHER | P01039321 | 01 | TX | RR MEDICARE | OTHER |