Provider Demographics
NPI:1215912365
Name:KULIEV, AGADADASH (MD)
Entity type:Individual
Prefix:MR
First Name:AGADADASH
Middle Name:
Last Name:KULIEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2741
Mailing Address - Country:US
Mailing Address - Phone:713-463-5527
Mailing Address - Fax:713-463-3784
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043
Practice Address - Country:US
Practice Address - Phone:713-463-5527
Practice Address - Fax:713-463-3784
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179501501Medicaid
TX8G3806Medicare PIN
TX179501501Medicaid
P00335533Medicare PIN