Provider Demographics
NPI:1609835925
Name:NORTH TEXAS DIABETES & ENDOCRINOLOGY
Entity Type:Organization
Organization Name:NORTH TEXAS DIABETES & ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-222-2700
Mailing Address - Street 1:PO BOX 293295
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-3295
Mailing Address - Country:US
Mailing Address - Phone:214-222-2700
Mailing Address - Fax:214-222-2705
Practice Address - Street 1:190 CIVIC CIR
Practice Address - Street 2:#272
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3424
Practice Address - Country:US
Practice Address - Phone:214-222-2700
Practice Address - Fax:214-222-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2924207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163475001Medicaid
TXDB7653OtherRAILROAD MEDICARE
TXDB7653OtherRAILROAD MEDICARE
G09237Medicare UPIN