Provider Demographics
NPI:1619487360
Name:BAMD ANESTHESIA PLLC
Entity Type:Organization
Organization Name:BAMD ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELFATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-983-1787
Mailing Address - Street 1:PO BOX 494439
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-4439
Mailing Address - Country:US
Mailing Address - Phone:214-310-3816
Mailing Address - Fax:
Practice Address - Street 1:3453 SAINT FRANCIS AVE STE 125
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6098
Practice Address - Country:US
Practice Address - Phone:214-983-1787
Practice Address - Fax:214-292-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID