MEDICARE: ISMAEL S MOHAMED ZAIN

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1730618976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAEL S MOHAMED ZAIN

Provider Business Mailing Address
First Line	:	12101 DESSAU RD APT 1105
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2086
Country	:	US
Telephone Number	:	201-982-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	12101 DESSAU RD APT 1105
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2086
Country	:	US
Telephone Number	:	201-982-3404
Fax Number	:

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

Provider Enumeration Date	:	06/10/2017
Last Update Date	:	07/21/2022

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Directions to “ ISMAEL S MOHAMED ZAIN ” Practice Location

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