=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831406958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GHOLAM A. KIANI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2010
-----------------------------------------------------
Last Update Date | 09/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5007 S MCCOLL RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-8080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-618-0634
-----------------------------------------------------
Fax | 956-686-7471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 720206
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-0206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-618-0634
-----------------------------------------------------
Fax | 956-686-7471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DIANA J MILLIGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-618-0634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | K6870
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------