Provider Demographics
NPI:1114974011
Name:AMJADI, NIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:AMJADI
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 1:4310 JAMES CASEY ST.
Mailing Address - Street 2:BLDG 1, SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-504-7411
Mailing Address - Fax:512-215-8824
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:BLDG. 1, SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1157
Practice Address - Country:US
Practice Address - Phone:512-504-7411
Practice Address - Fax:512-215-8824
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8596207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167376605Medicaid
TXP00704409OtherRAILROAD MEDICARE
TX8BX087OtherBCBSTX
TX167376604Medicaid
TX167376602Medicaid
TX167376603Medicaid
TXP00334347OtherMEDICARE RAILROAD
TX8BX087OtherBCBSTX
TX167376605Medicaid
TX8G5738Medicare PIN
TXH49430Medicare UPIN
TX167376602Medicaid