MEDICARE: COLLIN COUNTY ONCOLOGY ASSOCIATES, PA

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	207RH0003X	Hematology & Oncology Physician	N0390	TX

General Provider Information

NPI Number	:	1881917037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIN COUNTY ONCOLOGY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	PO BOX 941929
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75094-1929
Country	:	US
Telephone Number	:	972-639-1311
Fax Number	:	972-377-3156

Provider Business Practice Location Address
First Line	:	4101 W SPRING CREEK PKWY
Second Line	:	SUITE 300
City	:	PLANO
State	:	TX
Zip	:	75024-5307
Country	:	US
Telephone Number	:	214-530-0983
Fax Number	:	972-377-3156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KHUSROO MOHAMMAD QURESHI
Credential	:	M.D
Telephone Number	:	972-639-1311

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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