Provider Demographics
NPI:1073714200
Name:ANEES, MUKHTAR (MD)
Entity Type:Individual
Prefix:
First Name:MUKHTAR
Middle Name:
Last Name:ANEES
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 1:701 E RENDON CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7536
Mailing Address - Country:US
Mailing Address - Phone:817-293-9292
Mailing Address - Fax:817-551-0616
Practice Address - Street 1:701 E RENDON CROWLEY RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-293-9292
Practice Address - Fax:817-551-0616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5142174400000X, 207RG0100X
GA073220207RG0100X
OH35.040022207RG0100X
IN01092778A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110114916OtherMEDICARE RR
TX099394103Medicaid
TX8AJ623OtherBCBS
TX4277451OtherAETNA
TXB20908Medicare UPIN
TX099394103Medicaid