| Colleyville Md Associates | |
|
305 Boulder Dr Southlake TX 76092-3726 | |
| (682) 559-6333 | |
| (469) 854-2286 |
| Full Name | Colleyville Md Associates |
|---|---|
| Speciality | Family Medicine |
| Location | 305 Boulder Dr, Southlake, Texas |
| Authorized Official Name and Position | Atiya Iqbal (OWNER) |
| Authorized Official Contact | 6825596333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colleyville Md Associates 305 Boulder Dr Southlake TX 76092-3726 Ph: (682) 559-6333 | Colleyville Md Associates 305 Boulder Dr Southlake TX 76092-3726 Ph: (682) 559-6333 |
| NPI Number | 1851760979 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 09/18/2015 |
| Medicare PECOS PAC ID | 1759684681 |
|---|---|
| Medicare Enrollment ID | O20160126002331 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851760979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Texas) | Primary |
| Provider Name | Mohammad N Uddin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013052406 PECOS PAC ID: 6507886637 Enrollment ID: I20080211000078 |
| Provider Name | Atiya Iqbal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013052570 PECOS PAC ID: 5496775520 Enrollment ID: I20081006000605 |
| Provider Name | Gurdish K Sandhu-kaler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841635885 PECOS PAC ID: 2264675495 Enrollment ID: I20130906000637 |
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