MEDICARE: DALLAS ORTHOPEDIC ASSOCIATES 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	111NR0400X	Rehabilitation Chiropractor	10814	TX
2	207X00000X	Orthopaedic Surgery Physician
3	207X00000X	Orthopaedic Surgery Physician	P0984	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0984	OTHER	TX	TEXAS LICENSE NUMBER
2	1174604474	OTHER	TX	INDIVIDUAL NPI FOR DR. KHAWAJA NIMR IKRAM

General Provider Information

NPI Number	:	1881103489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS ORTHOPEDIC ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	10455 N CENTRAL EXPY STE 109-125
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2213
Country	:	US
Telephone Number	:	469-518-7853
Fax Number	:	469-232-9917

Provider Business Practice Location Address
First Line	:	1102 N GALLOWAY AVE
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2436
Country	:	US
Telephone Number	:	469-518-7853
Fax Number	:	469-232-9917

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. KHAWAJA NIMR IKRAM
Credential	:	DO
Telephone Number	:	469-404-9488

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	04/27/2022

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