Individual
IFTHEKAR UNNISSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21372 PROVINCIAL BLVD, KATY, TX 77450-7580
(281) 578-9766
(281) 578-6540
Mailing address
21372 PROVINCIAL BLVD, KATY, TX 77450-7580
(281) 578-9766
(281) 578-6540
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J1416
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016LG
BLUECROSS BLUESHIELD OF TEXAS
TX
05
—
149703401
—
TX
05
—
149703403
—
TX
Enumeration date
08/11/2006
Last updated
02/17/2009
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