MEDICARE: ARYA MADANI

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1407363864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARYA MADANI

Provider Business Mailing Address
First Line	:	4333 VINEYARD CREEK DR
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-1129
Country	:	US
Telephone Number	:	817-966-6290
Fax Number	:

Provider Business Practice Location Address
First Line	:	12221 MERIT DR STE 1600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2210
Country	:	US
Telephone Number	:	800-369-8397
Fax Number	:

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

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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Directions to “ ARYA MADANI ” Practice Location

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