1326302753 NPI number — MUNZER HAQUE

Table of content: MUNZER HAQUE (NPI 1326302753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326302753 NPI number — MUNZER HAQUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAQUE
Provider First Name:
MUNZER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1326302753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3814 TIMBERLAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75023-7727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-971-5593
Provider Business Mailing Address Fax Number:
972-516-4952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3814 TIMBERLAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75023-7727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-881-4374
Provider Business Practice Location Address Fax Number:
972-516-4952
Provider Enumeration Date:
06/29/2012

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: 251E00000X , with the licence number:  009121 , 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: 182339501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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