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NPI Code Detail

MEDICARE: INTERNAL MEDICINE CARE GROUP

MEDICARE: INTERNAL MEDICINE CARE GROUP
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
1207R00000XInternal Medicine PhysicianN8796TX

General Provider Information

NPI Number : 1780133512
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNAL MEDICINE CARE GROUP
Provider Business Mailing Address
First Line : PO BOX 92459
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-0104
Country : US
Telephone Number : 610-751-0698
Fax Number :
Provider Business Practice Location Address
First Line : 2260 COLLEGE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1952
Country : US
Telephone Number : 817-870-3627
Fax Number : 817-870-3636
Authorized Official
Title or Position : MANAGER
Name : NADEEM ZAMAN KAYANI
Credential :
Telephone Number : 610-751-0698
Provider Enumeration Date : 09/21/2016
Last Update Date : 08/24/2017

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Directions to “INTERNAL MEDICINE CARE GROUP ” Practice Location

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