MEDICARE: ARSALLA ISLAM MD

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	208600000X	Surgery Physician	N0123	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8ER572	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427252378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARSALLA ISLAM MD

Provider Business Mailing Address
First Line	:	PO BOX 2078
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-6156
Country	:	US
Telephone Number	:	817-562-5905
Fax Number	:	817-562-5906

Provider Business Practice Location Address
First Line	:	3100 N TARRANT PKWY STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8616
Country	:	US
Telephone Number	:	817-562-5905
Fax Number	:	817-562-5906

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	01/25/2023

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Directions to “ ARSALLA ISLAM MD” Practice Location

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