Provider Demographics
NPI: | 1447287404 |
---|---|
Name: | FOTEH, ABEER MUFID (DPM) |
Entity type: | Individual |
Prefix: | MISS |
First Name: | ABEER |
Middle Name: | MUFID |
Last Name: | FOTEH |
Suffix: | |
Gender: | F |
Credentials: | DPM |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 11102 BROOK MILL CT |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77065-3221 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-894-2579 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1666 W BAKER RD STE C |
Practice Address - Street 2: | |
Practice Address - City: | BAYTOWN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77521-2271 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-837-8371 |
Practice Address - Fax: | 281-837-8374 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-27 |
Last Update Date: | 2009-08-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 1455 | 213E00000X, 213ES0103X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 043875602 | Medicaid | |
TX | 00350P | Medicare ID - Type Unspecified | |
TX | U75921 | Medicare UPIN |