Provider Demographics
NPI:1992219216
Name:IKRAM, ASAD (MD)
Entity type:Individual
Prefix:
First Name:ASAD
Middle Name:
Last Name:IKRAM
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 1:713 GRAINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3261
Mailing Address - Country:US
Mailing Address - Phone:817-336-3968
Mailing Address - Fax:817-336-7817
Practice Address - Street 1:713 GRAINGER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3261
Practice Address - Country:US
Practice Address - Phone:817-336-3968
Practice Address - Fax:817-336-7817
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2017-1004390200000X
MA290773390200000X, 2084N0400X
NMMD2022-0007390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program