IMTIAZ ALAM MD PA
Suppliers at Park Bend Dr, Austin, TX

License number
Texas 29482
Category
Suppliers
Type
Community/Retail Pharmacy
Owner
Name: TAMMIE MISKIMINS
Title: MGR. LICENSING & THIRD PARTY
Phone: (817) 572-0009
Address
Address 2
2200 Park Bend Dr BLDG 1, Austin, TX 78758
1620 W. Hwy NORTHWEST STE. 100, Grapevine, TX 76051
National Provider ID: 1144623489
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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IMTIAZ ALAM, M.D., PA

Austin, TX

Doing business as:
Imtiaz Alam, M.D., PA<br>Imtiaz Alam MD
Registration:
Sep 24, 2003
Phone:
(512) 339-8831 (Phone)
Addresses:
2200 Park Bnd Dr BLDG 1-300 BOX 5, Austin, TX 78758 (Mailing)
12201 Renfert Way, Austin, TX 78758
State ID:
0800250519
Business type:
Professional Association
President , Treasurer , Secretary , Director , Member , Vice-President:
Imtiaz Alam (President , Treasurer , Secretary , Director , Member , Vice-President)
TIN:
32035718082

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