MEDICARE: FIROZ MEDICAL GROUP, 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	K9527	TX

General Provider Information

NPI Number	:	1588986111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIROZ MEDICAL GROUP, PA.

Provider Business Mailing Address
First Line	:	PO BOX 93090
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-1090
Country	:	US
Telephone Number	:	320-282-6015
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 S 4TH ST
Second Line	:	A
City	:	WILLS POINT
State	:	TX
Zip	:	75169-2632
Country	:	US
Telephone Number	:	320-282-6015
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUSTAFA FIROZ
Credential	:	M.D.
Telephone Number	:	320-282-6015

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	02/24/2010

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