MEDICARE: NIKHAT A. QURESHI, M.D., P.A.

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	207RP1001X	Pulmonary Disease Physician	G9192	TX

General Provider Information

NPI Number	:	1306023924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIKHAT A. QURESHI, M.D., P.A.

Provider Business Mailing Address
First Line	:	4255 BRYANT IRVIN RD., #102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-370-9800
Fax Number	:	817-346-1227

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4224
Country	:	US
Telephone Number	:	817-370-9800
Fax Number	:	817-346-1227

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. NIKHAT A QURESHI
Credential	:	MD
Telephone Number	:	817-370-9800

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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