Basic Information
| Provider Information | |||||||||
| NPI: | 1154546604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORESHI | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | KASHIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4350,LOCKHILL SELMA | ||||||||
| Address2: | SUIT 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109493773 | ||||||||
| FaxNumber: | 2104937289 | ||||||||
| Practice Location | |||||||||
| Address1: | 4350,LOCKHILL SELMA | ||||||||
| Address2: | SUIT 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109493773 | ||||||||
| FaxNumber: | 2104937289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 11/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301097613 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1154546604 | 05 | MI | MEDICAID |