Provider Demographics
NPI:1114320363
Name:EMERGENCY PHYSICIANS CARE OF LAKEWOOD, PLLC
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS CARE OF LAKEWOOD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KASHIF
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-202-8646
Mailing Address - Street 1:1926 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7954
Mailing Address - Country:US
Mailing Address - Phone:469-202-8646
Mailing Address - Fax:
Practice Address - Street 1:1926 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7954
Practice Address - Country:US
Practice Address - Phone:469-202-8646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty