Provider Demographics
NPI:1902817778
Name:TAMIM, MARWAN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:Y
Last Name:TAMIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W INTERSTATE 30
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5702
Mailing Address - Country:US
Mailing Address - Phone:972-240-4242
Mailing Address - Fax:972-240-4222
Practice Address - Street 1:517 W INTERSTATE 30
Practice Address - Street 2:SUITE C
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5702
Practice Address - Country:US
Practice Address - Phone:972-240-4242
Practice Address - Fax:972-240-4222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0035207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100251101Medicaid
TXB26858Medicare UPIN
00TL92Medicare PIN