Provider Demographics
NPI:1124083845
Name:QAISAR, ADEEL (MD)
Entity type:Individual
Prefix:
First Name:ADEEL
Middle Name:
Last Name:QAISAR
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 1:9105 LA STRADA CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-7809
Mailing Address - Country:US
Mailing Address - Phone:573-489-0108
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:920 STANTON L YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-4351
Practice Address - Fax:405-271-8695
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0387207L00000X, 207LC0200X, 207LP2900X
MO2003002800207L00000X
OK33644207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01446644OtherRR
TX301198301Medicaid
TX301198305Medicaid
TX301198305OtherBCBS
TXTXB152517Medicare PIN
TX330822YK6UMedicare UPIN