Healthcare Provider Details

I. General information

NPI: 1881944718
Provider Name (Legal Business Name): AHMAD E QAWASMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AHMAD E KAWASMI M.D.

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S COIT RD STE 20
PROSPER TX
75078-2928
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 945-204-7900
  • Fax: 945-204-7901
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-885-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101717
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14536
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR5306
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR5306
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: