Provider Demographics
NPI:1871804112
Name:BARIATRIC MANAGMENT INC
Entity type:Organization
Organization Name:BARIATRIC MANAGMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-339-1353
Mailing Address - Street 1:PO BOX 56612
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77256-6612
Mailing Address - Country:US
Mailing Address - Phone:713-339-1353
Mailing Address - Fax:713-339-1838
Practice Address - Street 1:5757 WESTHEIMER RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5721
Practice Address - Country:US
Practice Address - Phone:713-339-1353
Practice Address - Fax:713-339-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8186208600000X
TXSA00092363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty