Provider Demographics
NPI:1326106899
Name:AZMABALANI, GITI (DO)
Entity Type:Individual
Prefix:
First Name:GITI
Middle Name:
Last Name:AZMABALANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GITI
Other - Middle Name:
Other - Last Name:AZMABALANI EBRAHIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12221 MERIT DR.
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2235
Mailing Address - Country:US
Mailing Address - Phone:214-217-1911
Mailing Address - Fax:214-217-1912
Practice Address - Street 1:12221 MERIT DR.
Practice Address - Street 2:SUITE 1500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2235
Practice Address - Country:US
Practice Address - Phone:214-217-1911
Practice Address - Fax:214-217-1912
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185070301Medicaid
TXP00409008OtherRAILROAD MEDICARE
TX8A5415OtherBCBS
TX8J3370Medicare PIN
TX185070301Medicaid
TXI71392Medicare UPIN