Provider Demographics
NPI:1215971072
Name:SHARAF DIWAN, M.D., P.A. LLC
Entity type:Organization
Organization Name:SHARAF DIWAN, M.D., P.A. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARAF
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-604-0005
Mailing Address - Street 1:18220 TOMBALL PKWY
Mailing Address - Street 2:#230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:832-604-0005
Mailing Address - Fax:832-604-0103
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:#230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:832-604-0005
Practice Address - Fax:832-604-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6920207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1401523-23Medicaid
TX00566UMedicare ID - Type Unspecified
TX1401523-23Medicaid