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NPI Code Detail

MEDICARE: ABDUL BASIT M.D.

MEDICARE:   ABDUL  BASIT  M.D.
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
1207RC0000XCardiovascular Disease PhysicianQ0409TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P02674505OTHERTXMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38SQ844OTHERTXBCBS-TX

General Provider Information

NPI Number : 1720081631
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDUL BASIT M.D.
Provider Business Mailing Address
First Line : 4400 HERITAGE TRACE PKWY STE 208
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-8902
Country : US
Telephone Number : 817-518-9005
Fax Number : 817-518-9015
Provider Business Practice Location Address
First Line : 4400 HERITAGE TRACE PKWY STE 208
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-8902
Country : US
Telephone Number : 817-518-9005
Fax Number : 817-518-9015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 04/20/2023

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