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General NPI Number Information
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NPI Number | 1336892637
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Entity Type | Organization
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Legal Business Name | BAKER STREET MEDICAL GROUP (DE), P.A.
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 8951 CYPRESS WATERS BLVD STE 160-1045
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City | DALLAS
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State | TX
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Zip | 75019
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Country | US
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Telephone | 301-706-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 8951 CYPRESS WATERS BLVD STE 160-1045
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City | DALLAS
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State | TX
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Zip | 75019
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Country | US
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Telephone | 301-706-4461
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEX MOHSENI
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Credential | MD
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Telephone | 301-706-4461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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