MEDICARE: FROOD EELANI DO

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	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417977703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FROOD EELANI DO

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/25/2025

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Directions to “ FROOD EELANI DO” Practice Location

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