Healthcare Provider Details

I. General information

NPI: 1104150119
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MERCEDES ST
BENBROOK TX
76126-2593
US

IV. Provider business mailing address

320 MERCEDES ST
BENBROOK TX
76126-2593
US

V. Phone/Fax

Practice location:
  • Phone: 817-249-7323
  • Fax: 817-887-2193
Mailing address:
  • Phone: 817-249-7323
  • Fax: 817-887-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN3283
License Number StateTX

VIII. Authorized Official

Name: DR. RUBIA SADIQ
Title or Position: OWNER
Credential: MD
Phone: 817-249-7323