MEDICARE: NORTH TEXAS CONCIERGE MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1215761283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS CONCIERGE MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	1400 N COIT RD STE 1401
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6660
Country	:	US
Telephone Number	:	469-425-2659
Fax Number	:	469-640-9042

Provider Business Practice Location Address
First Line	:	1400 N COIT RD STE 1401
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6660
Country	:	US
Telephone Number	:	972-333-0802
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CHIEF MEDICAL OFFICER
Name	:	FOAD KIAMANESH
Credential	:	MD
Telephone Number	:	469-425-2659

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	09/18/2024

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