Provider Demographics
NPI:1356913297
Name:DALLAS ARTHRITIS AND AUTOIMMUNE DISEASE CENTER PLLC
Entity type:Organization
Organization Name:DALLAS ARTHRITIS AND AUTOIMMUNE DISEASE CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASI
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:732-523-4103
Mailing Address - Street 1:425 N HIGHLAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7383
Mailing Address - Country:US
Mailing Address - Phone:090-350-8423
Mailing Address - Fax:903-553-4388
Practice Address - Street 1:425 N HIGHLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7383
Practice Address - Country:US
Practice Address - Phone:903-508-4230
Practice Address - Fax:903-553-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX427204901Medicaid