MEDICARE: DR. AYESHA KAMAL QUAYYUM 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
1	207Q00000X	Family Medicine Physician	R2445	TX

General Provider Information

NPI Number	:	1720348782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYESHA KAMAL QUAYYUM M.D.

Provider Business Mailing Address
First Line	:	4576 WILBARGER ST
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 DALLAS PKWY STE 210
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-4181
Country	:	US
Telephone Number	:	972-640-1787
Fax Number	:

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

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	03/02/2026

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