Healthcare Provider Details

I. General information

NPI: 1326662891
Provider Name (Legal Business Name): MEDCORE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W DEYOUNG ST
MARION IL
62959-5884
US

IV. Provider business mailing address

6918 CAMP BULLIS RD
SAN ANTONIO TX
78256-2236
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-4445
  • Fax:
Mailing address:
  • Phone: 210-617-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: AAMIR EHSAN
Title or Position: PRESIDENT
Credential:
Phone: 210-497-0445