Healthcare Provider Details

I. General information

NPI: 1700232493
Provider Name (Legal Business Name): NISHATH ALIMAN FARHAD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NISHATH ALIMAN AHMED

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW H K DODGEN LOOP
TEMPLE TX
76502-1814
US

IV. Provider business mailing address

821 LOTUS DR
RICHARDSON TX
75081-5197
US

V. Phone/Fax

Practice location:
  • Phone: 254-935-5063
  • Fax:
Mailing address:
  • Phone: 713-392-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10057595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: