Provider Demographics
NPI:1780133512
Name:INTERNAL MEDICINE CARE GROUP
Entity type:Organization
Organization Name:INTERNAL MEDICINE CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:ZAMAN
Authorized Official - Last Name:KAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-751-0698
Mailing Address - Street 1:PO BOX 92459
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0104
Mailing Address - Country:US
Mailing Address - Phone:610-751-0698
Mailing Address - Fax:
Practice Address - Street 1:2260 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1952
Practice Address - Country:US
Practice Address - Phone:817-870-3627
Practice Address - Fax:817-870-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty