Provider Demographics
NPI:1730259268
Name:MUSTAPHA KIBIRIGE, MD, PA
Entity type:Organization
Organization Name:MUSTAPHA KIBIRIGE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPATHAMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBIRIGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-532-7311
Mailing Address - Street 1:PO BOX 741126
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1126
Mailing Address - Country:US
Mailing Address - Phone:713-838-9153
Mailing Address - Fax:713-592-5574
Practice Address - Street 1:2656 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2664
Practice Address - Country:US
Practice Address - Phone:713-838-9153
Practice Address - Fax:713-592-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112314304Medicaid
TX180483301Medicaid
TX0009JKOtherBCBS
TX101772504Medicaid
TX160150201Medicaid
TX112314304Medicaid
TX101772504Medicaid
TX00674UMedicare PIN
TX160150201Medicaid