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NPI Code Detail

MEDICARE: TABASUM IMRAN MD

MEDICARE: TABASUM IMRAN MD
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
1207Q00000XFamily Medicine PhysicianE6776AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801057583
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABASUM IMRAN MD
Provider Business Mailing Address
First Line : 612 S 12TH ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4702
Country : US
Telephone Number : 479-785-2431
Fax Number : 479-494-7787
Provider Business Practice Location Address
First Line : 1301 S E ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4716
Country : US
Telephone Number : 479-785-2431
Fax Number : 479-494-7787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2008
Last Update Date : 04/14/2017

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Directions to “ TABASUM IMRAN MD” Practice Location

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