Provider Demographics
NPI:1992762033
Name:MEMON, ILYAS M (MD)
Entity type:Individual
Prefix:
First Name:ILYAS
Middle Name:M
Last Name:MEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUHAMMAD
Other - Middle Name:ILYAS
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26103 INTERSTATE 45
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1902
Mailing Address - Country:US
Mailing Address - Phone:281-764-9500
Mailing Address - Fax:281-764-9501
Practice Address - Street 1:26103 INTERSTATE 45
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1902
Practice Address - Country:US
Practice Address - Phone:281-764-9500
Practice Address - Fax:281-764-9501
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2655207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188779606Medicaid