Provider Demographics
NPI:1396056966
Name:QURESH, QURETUL (MD)
Entity type:Individual
Prefix:
First Name:QURETUL
Middle Name:
Last Name:QURESH
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 1:1022 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5828
Mailing Address - Country:US
Mailing Address - Phone:972-674-9910
Mailing Address - Fax:972-666-5166
Practice Address - Street 1:931 STATE HWY 121, BLDG 1, SUITE 1100
Practice Address - Street 2:COTTONWOOD CREEK PROFESSIONAL OFFICE PARK
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-674-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244983207R00000X
SC36142207R00000X
TXR8466207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX406561701Medicaid