Provider Demographics
NPI:1285083618
Name:IRANI, MALCOLM KHODADAD (MD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:KHODADAD
Last Name:IRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MALCOLM
Other - Middle Name:
Other - Last Name:IRANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6670 BERTNER AVE
Mailing Address - Street 2:R2-216
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST STE 1201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2740
Practice Address - Country:US
Practice Address - Phone:713-441-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT7602207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program