MEDICARE: MOHAMED SUMMAKIA 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	2084N0400X	Neurology Physician	N0488	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB141949	OTHER	TX	MEDICARE FOR TARRANT COUNTY
4	P00784505	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1962430553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED SUMMAKIA M.D.

Provider Business Mailing Address
First Line	:	9607 VALLEY LAKE LN
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-5014
Country	:	US
Telephone Number	:	469-323-8112
Fax Number	:	817-549-7779

Provider Business Practice Location Address
First Line	:	2516 LILLIAN MILLER PKWY
Second Line	:	STE 110
City	:	DENTON
State	:	TX
Zip	:	76210-7205
Country	:	US
Telephone Number	:	940-243-0202
Fax Number	:	940-243-0404

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	01/06/2026

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Directions to “ MOHAMED SUMMAKIA M.D.” Practice Location

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