Basic Information
| Provider Information | |||||||||
| NPI: | 1386973782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMTIAZ | ||||||||
| FirstName: | BATOOL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9229 LBJ FWY | ||||||||
| Address2: | ATTN: POST ACUTE | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752433405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6822363656 | ||||||||
| FaxNumber: | 2145701692 | ||||||||
| Practice Location | |||||||||
| Address1: | 9229 LBJ FWY | ||||||||
| Address2: | ATTN: POST ACUTE | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752433405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6822363656 | ||||||||
| FaxNumber: | 2145701692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2009 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 254285-1 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207Q00000X | N9072 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 356876801 | 05 | TX | MEDICAID | 356876802 | 05 | TX | MEDICAID |