Provider Demographics
NPI:1326302753
Name:HAQUE, MUNZER
Entity Type:Individual
Prefix:
First Name:MUNZER
Middle Name:
Last Name:HAQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7727
Mailing Address - Country:US
Mailing Address - Phone:972-971-5593
Mailing Address - Fax:972-516-4952
Practice Address - Street 1:3814 TIMBERLAKE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7727
Practice Address - Country:US
Practice Address - Phone:972-881-4374
Practice Address - Fax:972-516-4952
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009121251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182339501Medicaid
TX673190Medicare PIN
TX182339501Medicaid