Provider Demographics
NPI:1497950091
Name:DR. IMTIAZ ALAM MD, PA
Entity Type:Organization
Organization Name:DR. IMTIAZ ALAM MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-719-4370
Mailing Address - Street 1:2200 PARK BEND DR
Mailing Address - Street 2:BLDG 1 STE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5387
Mailing Address - Country:US
Mailing Address - Phone:512-719-4370
Mailing Address - Fax:512-719-4371
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BLDG 1 STE300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5368
Practice Address - Country:US
Practice Address - Phone:512-719-4370
Practice Address - Fax:512-719-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3057174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1497950091Medicare PIN