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General NPI Number Information
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NPI Number | 1013407105
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Entity Type | Individual
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Provider Name | MOHAMMAD-ASAD BUKSH ILAHI DPM
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Gender | Male
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 701 S ZARZAMORA ST
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City | SAN ANTONIO
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State | TX
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Zip | 78207-5209
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Country | US
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Telephone | 210-358-7402
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Fax |
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Provider Business Mailing Address
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Address Line | 701 TUSCAN DR STE 220
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City | IRVING
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State | TX
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Zip | 75039-3838
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Country | US
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Telephone | 616-648-0613
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 3095
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License Number State | TX
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