Healthcare Provider Details

I. General information

NPI: 1003376963
Provider Name (Legal Business Name): AHMED KAZEM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W STATE HIGHWAY 114 STE 200
GRAPEVINE TX
76051-8648
US

IV. Provider business mailing address

2020 W STATE HIGHWAY 114 STE 200
GRAPEVINE TX
76051-8648
US

V. Phone/Fax

Practice location:
  • Phone: 817-912-8400
  • Fax:
Mailing address:
  • Phone: 817-912-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberV0441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: