Provider Demographics
NPI:1497231914
Name:BHATTY, MADIHA KHURRAM AHMED
Entity Type:Individual
Prefix:
First Name:MADIHA KHURRAM
Middle Name:AHMED
Last Name:BHATTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 KIRBY DR APT 1113
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-3943
Mailing Address - Country:US
Mailing Address - Phone:630-632-0005
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ FWY STE 1700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2759
Practice Address - Country:US
Practice Address - Phone:972-663-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30025970122300000X
TX389831223G0001X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty