Provider Demographics
NPI:1881103489
Name:DALLAS ORTHOPEDIC ASSOCIATES PLLC
Entity type:Organization
Organization Name:DALLAS ORTHOPEDIC ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAWAJA
Authorized Official - Middle Name:NIMR
Authorized Official - Last Name:IKRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-404-9488
Mailing Address - Street 1:10455 N CENTRAL EXPY STE 109-125
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2213
Mailing Address - Country:US
Mailing Address - Phone:469-518-7853
Mailing Address - Fax:469-232-9917
Practice Address - Street 1:1102 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2436
Practice Address - Country:US
Practice Address - Phone:469-518-7853
Practice Address - Fax:469-232-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10814111NR0400X
207X00000X
TXP0984207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0984OtherTEXAS LICENSE NUMBER
TX1174604474OtherINDIVIDUAL NPI FOR DR. KHAWAJA NIMR IKRAM