Provider Demographics
NPI:1427170224
Name:BIDIWALA, KHURSHID ABDUL SATTAR (MD)
Entity type:Individual
Prefix:DR
First Name:KHURSHID
Middle Name:ABDUL SATTAR
Last Name:BIDIWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17619 WAVERLY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6339
Mailing Address - Country:US
Mailing Address - Phone:281-861-8850
Mailing Address - Fax:
Practice Address - Street 1:17619 WAVERLY GROVE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6339
Practice Address - Country:US
Practice Address - Phone:281-861-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG86722080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC42639Medicare UPIN