Provider Demographics
NPI:1194996702
Name:AL KADDOUMI, BASHIR FARIS (MB, BS, MD)
Entity type:Individual
Prefix:DR
First Name:BASHIR
Middle Name:FARIS
Last Name:AL KADDOUMI
Suffix:
Gender:M
Credentials:MB, BS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249 STE 205
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:832-241-2001
Mailing Address - Fax:281-547-7464
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:832-241-2001
Practice Address - Fax:281-547-7464
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099922207RC0000X
TXP1959207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP1959OtherTEXAS PHYSICIAN PERMIT
TXP1959OtherTEXAS PHYSICIAN PERMIT