Basic Information
| Provider Information | |||||||||
| NPI: | 1801830716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFEEZ | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761101812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173365060 | ||||||||
| FaxNumber: | 8173361744 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761101812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173365060 | ||||||||
| FaxNumber: | 8173361744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | K4074 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 10012348 | 01 | AMERIGROUP | OTHER | 1635995 | 01 | LA | UNISYS MEDICAID | OTHER | 7128320 | 01 | AETNA | OTHER | P00001932 | 01 | RAILROAD MEDICARE | OTHER | 8654B6 | 01 | TX | BCBS OF TEXAS | OTHER | 160757401 | 05 | TX | MEDICAID |