Provider Demographics
NPI:1700401262
Name:IDEAL INFECTIOUS DISEASE &WOUND CARE CENTER PLLC
Entity Type:Organization
Organization Name:IDEAL INFECTIOUS DISEASE &WOUND CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHURSHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-738-3835
Mailing Address - Street 1:4105 HIGHWAY 121 STE 604
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3039
Mailing Address - Country:US
Mailing Address - Phone:682-738-3835
Mailing Address - Fax:682-738-3834
Practice Address - Street 1:4105 HIGHWAY 121 STE 604
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3039
Practice Address - Country:US
Practice Address - Phone:682-738-3835
Practice Address - Fax:682-738-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR4861OtherMEDICAL LICENSE
TXR4861OtherMEDICAL LICENSE