Healthcare Provider Details

I. General information

NPI: 1811191406
Provider Name (Legal Business Name): AMAL AHMAD AQUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD.
DALLAS TX
75390-7208
US

IV. Provider business mailing address

P.O. BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-8000
  • Fax: 214-456-8005
Mailing address:
  • Phone: 214-456-8000
  • Fax: 214-456-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP1-0023104
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberN3451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: