Provider Demographics
NPI:1548656283
Name:POONAWALA, IMRAN (DO)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:POONAWALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 HARGRAVE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4310
Mailing Address - Country:US
Mailing Address - Phone:281-890-6800
Mailing Address - Fax:291-890-6865
Practice Address - Street 1:13311 HARGRAVE RD STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4310
Practice Address - Country:US
Practice Address - Phone:281-890-6800
Practice Address - Fax:281-890-6865
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10052620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine