Basic Information
Provider Information | |||||||||
NPI: | 1912199654 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HASHEESH | ||||||||
FirstName: | ABDUL | ||||||||
MiddleName: | MONEIM | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 605 CREEKVIEW LN | ||||||||
Address2: |   | ||||||||
City: | COLLEYVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 760342811 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8177148902 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4401 BOOTH CALLOWAY RD | ||||||||
Address2: |   | ||||||||
City: | NORTH RICHLAND HILLS | ||||||||
State: | TX | ||||||||
PostalCode: | 761807371 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8172551000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/16/2007 | ||||||||
LastUpdateDate: | 09/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N5713 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.