Provider Demographics
NPI:1659564987
Name:COMPREHENSIVE MEDICAL CLINIC, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CLINIC, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NAUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-304-8915
Mailing Address - Street 1:2300 W FM 544 STE 290
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4931
Mailing Address - Country:US
Mailing Address - Phone:696-260-2014
Mailing Address - Fax:469-626-0205
Practice Address - Street 1:2300 W FM 544 STE 290
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4931
Practice Address - Country:US
Practice Address - Phone:469-626-0201
Practice Address - Fax:469-626-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CY97Medicare PIN