Basic Information
| Provider Information | |||||||||
| NPI: | 1629356514 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRESCENT MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 262302 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750262302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694415799 | ||||||||
| FaxNumber: | 9723980059 | ||||||||
| Practice Location | |||||||||
| Address1: | 9555 LEBANON RD | ||||||||
| Address2: | SUITE 1001 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750356095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723980051 | ||||||||
| FaxNumber: | 9723980059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 07/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | SAEED | ||||||||
| AuthorizedOfficialFirstName: | MALIK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4694415799 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | N4712 | 01 | TX | TX | OTHER |