Individual provider Active NPI

Muhammad Kashif Koreshi, MD

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1154546604
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301097613 Issued in MI
Practice address
4350,Lockhill Selma
Suit 200
San Antonio, TX 78249
Phone
(210) 949-3773
Fax
(210) 493-7289
NPI assigned
Apr 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301097613 MI Primary

Addresses

Primary practice location

4350,Lockhill Selma
Suit 200
San Antonio, TX 78249

Mailing address

4350,Lockhill Selma
Suit 200
San Antonio, TX 78249
Phone (210) 949-3773

Other practice location 1

2500 7th Ave S
suite 201
Escanaba, MI 49829-1176
Phone (906) 786-1710

Other identifiers 1

IdentifierTypeStateIssuer
1154546604MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110315000858 MI Practitioner - Family Practice 4486836244 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301097613MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Marquette Physician Practices Inc CurrentSince Sep 1, 2012 Accepting new patients
DLP Marquette Physician Practices Inc CurrentSince Sep 1, 2012 Accepting new patients
DLP Marquette Physician Practices Inc Family Medicine Current Accepting new patients

Locations

1414 W Fair Ave
Ste 344
Marquette, MI 49855
Phone (906) 225-3910

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1154546604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350,LOCKHILL SELMA",
            "address_2": "SUIT 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78249",
            "telephone_number": "210-949-3773",
            "fax_number": "210-493-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350,LOCKHILL SELMA",
            "address_2": "SUIT 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78249",
            "telephone_number": "210-949-3773",
            "fax_number": "210-493-7289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 7th Ave S",
            "address_2": "suite 201",
            "address_purpose": "LOCATION",
            "city": "Escanaba",
            "state": "MI",
            "postal_code": "498291176",
            "country_code": "US",
            "telephone_number": "906-786-1710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORESHI",
        "first_name": "MUHAMMAD",
        "middle_name": "KASHIF",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301097613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154546604",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.