Provider Demographics
NPI:1841396710
Name:KORESHI, SABEEN KASHIF (MD)
Entity Type:Individual
Prefix:
First Name:SABEEN
Middle Name:KASHIF
Last Name:KORESHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9172
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:302 W RECTOR ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5718
Practice Address - Country:US
Practice Address - Phone:210-358-0800
Practice Address - Fax:210-358-0850
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001903266OtherMS BCBS
WV3810007175Medicaid
WV2029043Medicare PIN
WVI62459Medicare UPIN
WV2029045Medicare PIN
WV001903266OtherMS BCBS
WV2029047Medicare PIN
WV2029046Medicare PIN