Provider Demographics
NPI:1588491906
Name:MAGNOLIA PHYSICIAN GROUP PLLC
Entity type:Organization
Organization Name:MAGNOLIA PHYSICIAN GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-482-3411
Mailing Address - Street 1:2323 W ROCHELLE ROAD
Mailing Address - Street 2:7 SUITES #D
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:205-482-3411
Mailing Address - Fax:
Practice Address - Street 1:2323 W ROCHELLE ROAD
Practice Address - Street 2:7 SUITES #D
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:205-482-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty