Provider Demographics
NPI:1861771131
Name:ELEDRISI, MOHSEN S (MD)
Entity type:Individual
Prefix:
First Name:MOHSEN
Middle Name:S
Last Name:ELEDRISI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 HICKORY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5052
Mailing Address - Country:US
Mailing Address - Phone:281-398-7585
Mailing Address - Fax:
Practice Address - Street 1:1903 HICKORY CHASE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5052
Practice Address - Country:US
Practice Address - Phone:281-398-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine