MEDICARE: DR. MOHAMMAD U KHUBAIB 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	207R00000X	Internal Medicine Physician	25MA10870500	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RS0010X	Sports Medicine (Internal Medicine) Physician	T7971	TX

General Provider Information

NPI Number	:	1477084440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD U KHUBAIB M.D.

Provider Business Mailing Address
First Line	:	1741 E BARDIN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-4836
Country	:	US
Telephone Number	:	817-702-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 E BARDIN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-4836
Country	:	US
Telephone Number	:	817-702-8700
Fax Number	:

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	07/05/2022

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