Provider Demographics
NPI:1104510577
Name:BURNABY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:BURNABY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:TAHSIN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-694-3989
Mailing Address - Street 1:6909 BENJAMIN WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1109
Mailing Address - Country:US
Mailing Address - Phone:405-694-3989
Mailing Address - Fax:
Practice Address - Street 1:6909 BENJAMIN WAY
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-1109
Practice Address - Country:US
Practice Address - Phone:405-694-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty