1942244066 NPI number — KANWAL Z HAIDER MD

Table of content: KANWAL Z HAIDER MD (NPI 1942244066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942244066 NPI number — KANWAL Z HAIDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAIDER
Provider First Name:
KANWAL
Provider Middle Name:
Z
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942244066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76199-0335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-927-3638
Provider Business Mailing Address Fax Number:
817-923-8769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76107-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-927-3638
Provider Business Practice Location Address Fax Number:
817-923-8769
Provider Enumeration Date:
06/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  M2969 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00600826 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 181932801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8X5110 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".