Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | K0095 | TX |
N | 111NI0900X | Internist | K0095 | TX |
Y | 207RC0000X | Internist - Cardiovascular Disease | K0095 | TX |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | K0095 | TX |
NPI | 1104825090 |
---|---|
Provider Name | Dr. Ali M. Kizilbash |
First Address | Irving, TX 75038-6117 |
Second Address | Irving, TX 75038-6117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105298706 | (05) | TX |
105298707 | (05) | TX |
105298708 | (05) | TX |
G30257 | (02) |