MEDICARE: FROOD EELANI, 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	207R00000X	Internal Medicine Physician	K5096	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0071EG	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1346262110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FROOD EELANI, D.O.

Provider Business Mailing Address
First Line	:	1315 6TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4327
Country	:	US
Telephone Number	:	817-921-3626
Fax Number	:	817-921-0391

Provider Business Practice Location Address
First Line	:	1315 6TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4327
Country	:	US
Telephone Number	:	817-921-3626
Fax Number	:	817-921-0391

Authorized Official
Title or Position	:	OWNER
Name	:	FROOD EELANI
Credential	:	D.O.
Telephone Number	:	817-921-3626

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/22/2020

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