Provider Demographics
NPI:1780757229
Name:DENSON-WILLIS, TAMIKA (MD)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:DENSON-WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18955 MEMORIAL NORTH DRIVE
Mailing Address - Street 2:#200
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-446-0148
Mailing Address - Fax:281-446-0149
Practice Address - Street 1:18955 MEMORIAL NORTH DR.
Practice Address - Street 2:#200
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-446-0148
Practice Address - Fax:281-446-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186156902Medicaid
TX186156902Medicaid
TX8L23776Medicare PIN