Provider Demographics
NPI:1386810653
Name:GHAZI, AASIA ISHRAT (MD)
Entity type:Individual
Prefix:
First Name:AASIA
Middle Name:ISHRAT
Last Name:GHAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 MCDERMOTT RD STE 310
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7798
Mailing Address - Country:US
Mailing Address - Phone:972-636-1750
Mailing Address - Fax:972-924-0388
Practice Address - Street 1:4674 MCDERMOTT RD STE 310
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7798
Practice Address - Country:US
Practice Address - Phone:972-636-1750
Practice Address - Fax:972-924-0388
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46891207R00000X, 208M00000X
CO390200000X
TXN9552207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301734502Medicaid
CO50175513Medicaid
TX301734502Medicaid
COCO303484Medicare PIN
TXTXB158365Medicare PIN
CO50175513Medicaid