Provider Demographics
NPI:1659806511
Name:AYESHA KANWAL DO PLLC
Entity Type:Organization
Organization Name:AYESHA KANWAL DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-703-8671
Mailing Address - Street 1:4819 RIVEROAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4656
Mailing Address - Country:US
Mailing Address - Phone:817-626-9744
Mailing Address - Fax:817-626-9962
Practice Address - Street 1:4819 RIVEROAKS BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-3098
Practice Address - Country:US
Practice Address - Phone:817-626-9744
Practice Address - Fax:817-626-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2313207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty