Healthcare Provider Details

I. General information

NPI: 1770679334
Provider Name (Legal Business Name): SHUAIB ABDULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-9047
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-9047
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-7521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1443
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: