MEDICARE: ASRA KERMANI MD, PA

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	M5280	TX

General Provider Information

NPI Number	:	1538320072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASRA KERMANI MD, PA

Provider Business Mailing Address
First Line	:	1207 ARISTA DR STE 101
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75032-6657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6810 LAKESHORE DRIVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:	214-883-1533
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASRA KERMANI
Credential	:	M.D.
Telephone Number	:	214-883-1533

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	12/21/2012

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