Provider Demographics
NPI:1720348782
Name:QUAYYUM, AYESHA KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:KAMAL
Last Name:QUAYYUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:
Other - Last Name:KAMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4576 WILBARGER ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6134
Practice Address - Country:US
Practice Address - Phone:817-494-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty