Provider Demographics
NPI:1538239884
Name:NIKAEIN, AFZAL (PHD)
Entity type:Individual
Prefix:DR
First Name:AFZAL
Middle Name:
Last Name:NIKAEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:BUILDING C, SUITE 768
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-5761
Mailing Address - Fax:972-566-7720
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:BUILDING C, SUITE 768
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-5761
Practice Address - Fax:972-566-7720
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6341291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45-HL12Medicare ID - Type Unspecified