Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ML60020733 | WA |
N | 208600000X | Surgeon | ML60020733 | WA |
Y | 2086X0206X | Surgical Oncologist | P5820 | TX |
NPI | 1013164219 |
---|---|
Provider Name | Andre Michel Ilbawi |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 28/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
320203801 (MDACC) | (05) | TX |
8DT083 | BCBS (MDACC) (01) | TX |