Provider Demographics
NPI:1992074710
Name:IMD HEALTHCARE AND IMAGING
Entity type:Organization
Organization Name:IMD HEALTHCARE AND IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-360-3269
Mailing Address - Street 1:7403 KINGS RIVER CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13107 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-5391
Practice Address - Country:US
Practice Address - Phone:281-360-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1456261QH0100X, 261QM2500X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology