MEDICARE: FARHANA ASIM M.D

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	208000000X	Pediatrics Physician	271324	NY
2	208000000X	Pediatrics Physician	0116022187	VA
3	208000000X	Pediatrics Physician	S1338	TX

General Provider Information

NPI Number	:	1366763666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHANA ASIM M.D

Provider Business Mailing Address
First Line	:	1111 W AIRPORT FWY STE 143
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6204
Country	:	US
Telephone Number	:	469-488-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 W AIRPORT FWY STE 143
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6204
Country	:	US
Telephone Number	:	469-488-4500
Fax Number	:

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

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	07/30/2019

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