Healthcare Provider Details
I. General information
NPI: 1598395477
Provider Name (Legal Business Name): CURE ALLERGY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4120 N COLLINS ST STE 100
ARLINGTON TX
76005-4553
US
IV. Provider business mailing address
4120 N COLLINS ST STE 100
ARLINGTON TX
76005-4553
US
V. Phone/Fax
- Phone: 817-678-5575
- Fax:
- Phone: 817-678-5575
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207KA0200X |
| Taxonomy | Allergy Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MOHAMMED
W
IMAM
Title or Position: OWNER
Credential: DO
Phone: 817-678-5575