Provider Demographics
NPI:1679762405
Name:HAQUE, WASIM AFZAL (MD)
Entity type:Individual
Prefix:
First Name:WASIM
Middle Name:AFZAL
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 293295
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-3295
Mailing Address - Country:US
Mailing Address - Phone:214-513-2300
Mailing Address - Fax:214-513-2333
Practice Address - Street 1:4101 KIRKPATRICK LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1415
Practice Address - Country:US
Practice Address - Phone:214-513-2300
Practice Address - Fax:214-513-2333
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2009-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL2924207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B3816Medicare PIN
TXG09237Medicare UPIN