Provider Demographics
NPI:1457736761
Name:ALAM, SAMIHA (DO)
Entity type:Individual
Prefix:
First Name:SAMIHA
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 N DENTON TAP RD STE 120
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2164
Mailing Address - Country:US
Mailing Address - Phone:972-429-1475
Mailing Address - Fax:
Practice Address - Street 1:760 N DENTON TAP RD STE 120
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2164
Practice Address - Country:US
Practice Address - Phone:972-429-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3697208000000X
TXR7642208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics