Provider Demographics
NPI:1386973782
Name:IMTIAZ, BATOOL (MD)
Entity type:Individual
Prefix:
First Name:BATOOL
Middle Name:
Last Name:IMTIAZ
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 1:6548 CROWN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7488
Mailing Address - Country:US
Mailing Address - Phone:214-501-3325
Mailing Address - Fax:214-570-1692
Practice Address - Street 1:6020 W PARKER RD STE 350
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8166
Practice Address - Country:US
Practice Address - Phone:214-501-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9072207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX356876801Medicaid
TX356876802Medicaid
TX477064YKP5Medicare PIN
TX356876801Medicaid