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General NPI Number Information
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NPI Number | 1003159104
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Entity Type | Individual
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Provider Name | MOHAMMED WASEEM IMAM D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 4120 N COLLINS ST STE 100
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City | ARLINGTON
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State | TX
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Zip | 76005-4553
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Country | US
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Telephone | 817-678-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 N COLLINS ST STE 100
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City | ARLINGTON
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State | TX
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Zip | 76005-4553
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Country | US
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Telephone | 817-678-5575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | R5274
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License Number State | TX
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