Provider Demographics
NPI:1962430553
Name:SUMMAKIA, MOHAMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:SUMMAKIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 VALLEY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5014
Mailing Address - Country:US
Mailing Address - Phone:469-323-8112
Mailing Address - Fax:817-549-7779
Practice Address - Street 1:2516 LILLIAN MILLER PKWY
Practice Address - Street 2:STE 110
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7205
Practice Address - Country:US
Practice Address - Phone:940-243-0202
Practice Address - Fax:940-243-0404
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN04882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB141949OtherMEDICARE FOR TARRANT COUNTY
TX201471401Medicaid
TX201471402OtherMEDICAID TPI NUMBER
TXP00784505OtherRAILROAD MEDICARE
TX8L9290Medicare PIN
TXP00784505OtherRAILROAD MEDICARE
TXI60713Medicare UPIN
TXI60713Medicare UPIN
TX201471406Medicaid