MEDICARE: DR. BASEM AHMED ABDELFATTAH M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	P9994	TX
2	207L00000X	Anesthesiology Physician	125-056323	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1568971141	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1467688853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASEM AHMED ABDELFATTAH M.D.

Provider Business Mailing Address
First Line	:	3453 SAINT FRANCIS AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6079
Country	:	US
Telephone Number	:	915-241-0997
Fax Number	:	214-292-9415

Provider Business Practice Location Address
First Line	:	3453 SAINT FRANCIS AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6079
Country	:	US
Telephone Number	:	214-983-1787
Fax Number	:	214-292-9415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2009
Last Update Date	:	12/15/2021

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