Provider Demographics
NPI:1417977703
Name:EELANI, FROOD (DO)
Entity Type:Individual
Prefix:
First Name:FROOD
Middle Name:
Last Name:EELANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4327
Mailing Address - Country:US
Mailing Address - Phone:817-921-3626
Mailing Address - Fax:817-921-0391
Practice Address - Street 1:1315 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4327
Practice Address - Country:US
Practice Address - Phone:817-921-3626
Practice Address - Fax:817-921-0391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071EGOtherBLUE CROSS BLUE SHIELD
TX096418102Medicaid
TX00208LMedicare ID - Type Unspecified
TX0071EGOtherBLUE CROSS BLUE SHIELD