MEDICARE: ALI BUSOUL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	T1308	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063915957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI BUSOUL DO

Provider Business Mailing Address
First Line	:	2830 S HULEN ST # 365
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1514
Country	:	US
Telephone Number	:	817-239-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 S HULEN ST # 365
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1514
Country	:	US
Telephone Number	:	817-239-3915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	05/15/2024

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