Provider Demographics
NPI:1114217403
Name:KARIM M. MEGHANI, MD, PA
Entity Type:Organization
Organization Name:KARIM M. MEGHANI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-820-3502
Mailing Address - Street 1:PO BOX 93267
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0112
Mailing Address - Country:US
Mailing Address - Phone:817-820-3502
Mailing Address - Fax:817-820-3505
Practice Address - Street 1:425 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1022
Practice Address - Country:US
Practice Address - Phone:817-820-3502
Practice Address - Fax:817-820-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5672381OtherAETNA NUMBER
TX89Y320OtherHMO BLUE #
TX00T18MOtherMEDICARE
TX250007058OtherMEDICARE RAILROAD
TX035953101OtherTPI NUMBER
TX035953101Medicaid
TX4113420OtherBLUE LINK #
TX8050734002OtherCIGNA PAL ID #
TX5672381OtherAETNA NUMBER