Healthcare Provider Details

I. General information

NPI: 1114238870
Provider Name (Legal Business Name): AMANI QASEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 ASBURY PARK DR
ROUND ROCK TX
78665-5014
US

IV. Provider business mailing address

4515 SETON CENTER PKWY SUITE 215
AUSTIN TX
78759-5290
US

V. Phone/Fax

Practice location:
  • Phone: 239-209-0821
  • Fax:
Mailing address:
  • Phone: 512-231-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP9698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: