Provider Demographics
NPI:1114974011
Name:AMJADI, NIMA (MD)
Entity type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:AMJADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-215-9722
Practice Address - Street 1:170 BENNEY LN STE 100
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5566
Practice Address - Country:US
Practice Address - Phone:512-504-7411
Practice Address - Fax:512-215-8824
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8596207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167376602Medicaid
TX167376605Medicaid
TXP00704409OtherRAILROAD MEDICARE
TX167376604Medicaid
TX167376603Medicaid
TX8BX087OtherBCBSTX
TXP00334347OtherMEDICARE RAILROAD
TX8BX087OtherBCBSTX
TX167376605Medicaid
TX8G5738Medicare PIN
TXH49430Medicare UPIN
TX167376602Medicaid