Provider Demographics
NPI:1750362919
Name:MIZRAHI, ELI M (MD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:M
Last Name:MIZRAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 548
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:713-331-1850
Mailing Address - Fax:713-526-2036
Practice Address - Street 1:12951 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1923
Practice Address - Country:US
Practice Address - Phone:713-526-5771
Practice Address - Fax:713-526-2036
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG17222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136898701Medicaid
TX136898704Medicaid
110134285OtherRR MEDICARE
TX136898708Medicaid
TXTXB116470Medicare PIN
80136GMedicare PIN
TXTXB115436Medicare PIN
88H945Medicare PIN
895029Medicare PIN
E79527Medicare UPIN