Provider Demographics
NPI:1932199833
Name:ISLAM, NURUL (MD)
Entity Type:Individual
Prefix:DR
First Name:NURUL
Middle Name:
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CENTRAL EXPY N
Mailing Address - Street 2:STE 2230
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:972-838-1401
Mailing Address - Fax:972-727-6005
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:STE 2230
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-838-1401
Practice Address - Fax:972-727-6005
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3690207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174164704Medicaid
TX174164702Medicaid
TX8V2170OtherBCBS
TX10019042OtherAMERIGROUP
TX174164705Medicaid
TX17556OtherPARKLAND
TX174164701Medicaid
TXI24295Medicare UPIN
TX8D3539Medicare ID - Type UnspecifiedDALLAS COUNTY MEDICARE
TX174164701Medicaid