| Md Trucare Pa | |
|
823 Ira E Woods Ave Ste 200 Grapevine TX 76051-4096 | |
| (817) 722-6078 | |
| (817) 722-6077 |
| Full Name | Md Trucare Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 823 Ira E Woods Ave Ste 200, Grapevine, Texas |
| Authorized Official Name and Position | Ayesha Ebrahim (CEO) |
| Authorized Official Contact | 2182050198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Md Trucare Pa Po Box 93685 Southlake TX 76092-0116 Ph: (218) 205-0198 | Md Trucare Pa 823 Ira E Woods Ave Ste 200 Grapevine TX 76051-4096 Ph: (817) 722-6078 |
| NPI Number | 1043754526 |
|---|---|
| Provider Enumeration Date | 12/19/2016 |
| Last Update Date | 03/04/2022 |
| Medicare PECOS PAC ID | 1557643467 |
|---|---|
| Medicare Enrollment ID | O20170127002129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043754526 | NPI | - | NPPES |
| Provider Name | Imran S Khawaja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073509253 PECOS PAC ID: 0749190890 Enrollment ID: I20160302001333 |
| Provider Name | Ayesha Ebrahim |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1831144609 PECOS PAC ID: 3678587862 Enrollment ID: I20170130000235 |
| Provider Name | Panchanok C Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609384197 PECOS PAC ID: 1759646177 Enrollment ID: I20180605002093 |
| Provider Name | Ayako Sugiyama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871128157 PECOS PAC ID: 8022433663 Enrollment ID: I20200730000572 |
| Provider Name | Jennifer Chineme Adesina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265055511 PECOS PAC ID: 2860817103 Enrollment ID: I20200804002661 |
| Provider Name | Melissa Ann Tarver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972193035 PECOS PAC ID: 2264848415 Enrollment ID: I20210312000653 |
| Provider Name | Aileen Fisher |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1881783876 PECOS PAC ID: 1658564398 Enrollment ID: I20210813002328 |
| Provider Name | Felix Granados |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972176154 PECOS PAC ID: 6406238617 Enrollment ID: I20220804002653 |
| Provider Name | Damian Hooker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972210870 PECOS PAC ID: 0446628796 Enrollment ID: I20221117003375 |
| Provider Name | Vivek Poudel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407581283 PECOS PAC ID: 2567832934 Enrollment ID: I20221229000138 |
| Provider Name | Sarah Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538840897 PECOS PAC ID: 2466814975 Enrollment ID: I20230816000530 |
| Provider Name | Maryam Sajjad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144954959 PECOS PAC ID: 5496104028 Enrollment ID: I20231207004070 |
| Provider Name | Ariana Rivero |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144980343 PECOS PAC ID: 5597118521 Enrollment ID: I20240125004704 |
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