MEDICARE: DR. SAEID ESMAEILY ARYAN D.O

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	207T00000X	Neurological Surgery Physician	P9148	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
2	8EM652	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1144487174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAEID ESMAEILY ARYAN D.O

Provider Business Mailing Address
First Line	:	1110 E STATE HIGHWAY 114
Second Line	:	STE 100
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5251
Country	:	US
Telephone Number	:	817-502-7411
Fax Number	:	817-502-7412

Provider Business Practice Location Address
First Line	:	9525 N BEACH ST STE 405
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6438
Country	:	US
Telephone Number	:	817-502-7411
Fax Number	:	817-502-7412

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	07/06/2022

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