Provider Demographics
NPI:1497832091
Name:COMMUNITY INFECTIOUS DISEASES, P.A.
Entity type:Organization
Organization Name:COMMUNITY INFECTIOUS DISEASES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-660-2533
Mailing Address - Street 1:PO BOX 852756
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-2756
Mailing Address - Country:US
Mailing Address - Phone:214-660-2533
Mailing Address - Fax:
Practice Address - Street 1:929 N GALLOWAY AVE
Practice Address - Street 2:STE. # 220
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2476
Practice Address - Country:US
Practice Address - Phone:214-660-2533
Practice Address - Fax:972-744-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7527207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163525201Medicaid
TX00269WMedicare ID - Type Unspecified