Provider Demographics
NPI:1992135909
Name:MIRDAMADIHA, AKRAM
Entity type:Individual
Prefix:
First Name:AKRAM
Middle Name:
Last Name:MIRDAMADIHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7417 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3203
Mailing Address - Country:US
Mailing Address - Phone:972-517-7174
Mailing Address - Fax:
Practice Address - Street 1:2101 W SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4103
Practice Address - Country:US
Practice Address - Phone:972-943-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124732363LF0000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care