Provider Demographics
NPI:1124473160
Name:AQTASH, OBADAH (MD)
Entity type:Individual
Prefix:
First Name:OBADAH
Middle Name:
Last Name:AQTASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4708 ALLIANCE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5362
Mailing Address - Country:US
Mailing Address - Phone:972-941-3100
Mailing Address - Fax:844-292-1461
Practice Address - Street 1:4708 ALLIANCE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5362
Practice Address - Country:US
Practice Address - Phone:972-941-3100
Practice Address - Fax:844-292-1461
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV1731207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease