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NPI Code Detail

MEDICARE: ABDULLAH ABDUSSALAM

MEDICARE: ABDULLAH ABDUSSALAM
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
1207RG0100XGastroenterology Physician036169814IL
2207RG0100XGastroenterology PhysicianS1745TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932442613
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDULLAH ABDUSSALAM
Provider Business Mailing Address
First Line : PO BOX 6278
Second Line :
City : FORT WORTH
State : TX
Zip : 76115-0278
Country : US
Telephone Number : 817-568-5467
Fax Number : 817-568-5474
Provider Business Practice Location Address
First Line : 2302 LONE STAR RD STE 200
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-8751
Country : US
Telephone Number : 682-341-7210
Fax Number : 682-341-7212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2013
Last Update Date : 06/10/2024

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