Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | N8470 | TX |
NPI | 1013203801 |
---|---|
Provider Name | Dr. Maheen Adam Wardak |
First Address | Dallas, TX 75284-0853 |
Second Address | Houston, TX 77030-2703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288369602 | (05) | TX |
8EC774 | BCBS (01) | TX |
P01305888 | RR MEDICARE (01) | TX |