Provider Demographics
NPI:1346460169
Name:FROTAN, MOHAMMAD AMIN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AMIN
Last Name:FROTAN
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 1:8230 WALNUT HILL LN STE 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4481
Mailing Address - Country:US
Mailing Address - Phone:214-369-5432
Mailing Address - Fax:214-369-5591
Practice Address - Street 1:8230 WALNUT HILL LN STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4481
Practice Address - Country:US
Practice Address - Phone:214-369-5432
Practice Address - Fax:214-369-5591
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28468208600000X, 2086S0102X
TXP26452086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399250YKQLMedicare PIN