Provider Demographics
NPI:1174604474
Name:IKRAM, KHAWAJA NIMR (DO)
Entity type:Individual
Prefix:DR
First Name:KHAWAJA
Middle Name:NIMR
Last Name:IKRAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:K
Other - Middle Name:NIMR
Other - Last Name:IKRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4090 MAPLESHADE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-0025
Mailing Address - Country:US
Mailing Address - Phone:214-592-9955
Mailing Address - Fax:214-592-9935
Practice Address - Street 1:5655 W SPRING CREEK PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4175
Practice Address - Country:US
Practice Address - Phone:214-592-9955
Practice Address - Fax:214-592-9935
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0984207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0984OtherTEXAS LICENSE NUMBER
TX083314701Medicaid
TXP0984OtherTEXAS LICENSE NUMBER
TXP0984OtherTEXAS LICENSE NUMBER