Provider Demographics
NPI:1699081422
Name:ARUN K MUKHOPADHYAY MD PA
Entity type:Organization
Organization Name:ARUN K MUKHOPADHYAY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUKHOPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-484-1253
Mailing Address - Street 1:11914 ASTORIA BLVD
Mailing Address - Street 2:STE 580
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6064
Mailing Address - Country:US
Mailing Address - Phone:281-484-1253
Mailing Address - Fax:281-481-1205
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:STE 580
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:281-412-2494
Practice Address - Fax:281-412-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE1909OtherLICENSE
TX=========OtherTAX IDENTIFICATION
TXB108Z84Medicare PIN