Provider Demographics
NPI:1679985931
Name:GHOLAM A KIANI M.D.,P.A.
Entity Type:Organization
Organization Name:GHOLAM A KIANI M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOLAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-992-9596
Mailing Address - Street 1:P.O. BOX 720206
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-803-0401
Mailing Address - Fax:956-322-5739
Practice Address - Street 1:5121 N JACKSON RD STE 10
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-7850
Practice Address - Country:US
Practice Address - Phone:956-877-2401
Practice Address - Fax:956-877-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6870207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148513802Medicaid
TX375959901Medicaid
TX581883OtherPTAN
00138HAB8KOtherPTAN
TX00138HOtherPTAN
TX45D1006440OtherCLIA