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1255330569

NPI Code Detail

MEDICARE: MOHAMMED AMIRUL ISLAM MD

MEDICARE: MOHAMMED AMIRUL ISLAM MD

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	207RC0000X	Cardiovascular Disease Physician	L4981	TX
2	207UN0901X	Nuclear Cardiology Physician	L4981	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70125373	OTHER	TX	TX DPS
2	L4981	OTHER	TX	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255330569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMED AMIRUL ISLAM MD

Provider Business Mailing Address
First Line	:	PO BOX 951406
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75395-1406
Country	:	US
Telephone Number	:	409-963-0000
Fax Number	:	409-963-1899

Provider Business Practice Location Address
First Line	:	3921 N TWIN CITY HWY
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2118
Country	:	US
Telephone Number	:	409-963-0000
Fax Number	:	409-963-1899

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/07/2023

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Directions to “ MOHAMMED AMIRUL ISLAM MD” Practice Location

Language	Start Address	Practice Location

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