Provider Demographics
NPI: | 1346436300 |
---|---|
Name: | BARIATRIC & MINIMALLY INVASIVE SURGERY OF NORTH TEXAS |
Entity type: | Organization |
Organization Name: | BARIATRIC & MINIMALLY INVASIVE SURGERY OF NORTH TEXAS |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | IKRAM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KURESHI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 214-335-7303 |
Mailing Address - Street 1: | PO BOX 913418 |
Mailing Address - Street 2: | |
Mailing Address - City: | SHERMAN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75091-3418 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-818-7208 |
Mailing Address - Fax: | 888-965-9987 |
Practice Address - Street 1: | 204 MEDICAL DR STE 260 |
Practice Address - Street 2: | |
Practice Address - City: | SHERMAN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75092-6366 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-465-6400 |
Practice Address - Fax: | 903-465-6400 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-09-24 |
Last Update Date: | 2020-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty |