MEDICARE: DR. SHAHRIAR SETOUDEH-MARAM 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	207Q00000X	Family Medicine Physician	M7611	TX

General Provider Information

NPI Number	:	1619950359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRIAR SETOUDEH-MARAM MD

Provider Business Mailing Address
First Line	:	3044 OLD DENTON RD STE 317
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5017
Country	:	US
Telephone Number	:	972-242-4440
Fax Number	:	972-242-4949

Provider Business Practice Location Address
First Line	:	3044 OLD DENTON RD STE 317
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5017
Country	:	US
Telephone Number	:	972-242-4440
Fax Number	:	972-242-4949

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/19/2014

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