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General NPI Number Information
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NPI Number | 1487970257
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Entity Type | Organization
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Legal Business Name | RENNER INTERNAL MEDICINE
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 3409 SPECTRUM BLVD STE 300
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City | RICHARDSON
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State | TX
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Zip | 75082-9713
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Country | US
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Telephone | 972-363-3298
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 ORANGE BLOSSOM CT
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City | PLANO
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State | TX
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Zip | 75025-3740
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Country | US
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Telephone | 972-363-6298
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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. SHAKIL AHMED
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Credential | M.D.
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Telephone | 972-363-6298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K9476
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License Number State | TX
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