MEDICARE: ZABIHULLAH WARDAK

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	2085R0001X	Radiation Oncology Physician	Q9546	TX

General Provider Information

NPI Number	:	1700177144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZABIHULLAH WARDAK

Provider Business Mailing Address
First Line	:	5801 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6403
Country	:	US
Telephone Number	:	214-645-8525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6403
Country	:	US
Telephone Number	:	214-645-8525
Fax Number	:

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

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	08/11/2016

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