Provider Demographics
NPI:1134130628
Name:ASIM, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:ASIM
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:PO BOX 93477
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9998
Mailing Address - Country:US
Mailing Address - Phone:214-415-6845
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:609 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2600
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3836
Practice Address - Country:US
Practice Address - Phone:214-415-6845
Practice Address - Fax:888-770-6360
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9717207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0085LYOtherBCBS
TX173329701Medicaid
201476795OtherTAX ID
201476795OtherTAX ID
G54194Medicare UPIN