MEDICARE: INFECTIOUS DISEASE DOCTORS OF DALLAS 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	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1821544214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASE DOCTORS OF DALLAS PLLC

Provider Business Mailing Address
First Line	:	2990 BLACKBURN ST
Second Line	:	SUITE 1102
City	:	DALLAS
State	:	TX
Zip	:	75204-3113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 BLACKBURN ST
Second Line	:	SUITE 1102
City	:	DALLAS
State	:	TX
Zip	:	75204-3113
Country	:	US
Telephone Number	:	316-519-0625
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZARTASH KHAN
Credential	:	MD
Telephone Number	:	316-519-0625

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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