Provider Demographics
NPI:1205093424
Name:ANJUM, AMINA (MD)
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:ANJUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMINA
Other - Middle Name:
Other - Last Name:DILNASHEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 N HIGHLAND AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7389
Mailing Address - Country:US
Mailing Address - Phone:903-957-0417
Mailing Address - Fax:903-957-0242
Practice Address - Street 1:300 N HIGHLAND AVE STE 330
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7389
Practice Address - Country:US
Practice Address - Phone:903-957-0417
Practice Address - Fax:903-957-0242
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH90624207R00000X
TXN8367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH90624OtherLICENSE#
TX285258403Medicaid
TXTXB133491Medicare PIN
TXTXB133490Medicare PIN
OH90624OtherLICENSE#