Provider Demographics
NPI:1447589494
Name:MAREDIA, MUSTAQ K (MD)
Entity type:Individual
Prefix:
First Name:MUSTAQ
Middle Name:K
Last Name:MAREDIA
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 1:7015 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2101
Mailing Address - Country:US
Mailing Address - Phone:888-897-2724
Mailing Address - Fax:
Practice Address - Street 1:7015 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2101
Practice Address - Country:US
Practice Address - Phone:888-897-2724
Practice Address - Fax:832-532-6423
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine