Active NPI
Isam S Kiblawi, M.D.
- Pediatrics Physician
- Mesquite, TX
National Provider Identifier
1891703161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- F-5605
- Practice address
- 2540 N Galloway Ave
Suite 204
Mesquite, TX 75150-6306 - Phone
- (972) 686-1777
- Fax
- (972) 686-7330
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | F-5605 | TX | Primary |
Addresses
Primary practice location
2540 N Galloway Ave
Suite 204
Mesquite, TX 75150-6306
Mailing address
2540 N Galloway Ave
Suite 204
Mesquite, TX 75150-6306
Phone (972) 686-1777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150106001920 | TX | Order and Referring Only - Pediatric Medicine | 4486977030 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F-5605 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891703161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2540 N GALLOWAY AVE",
"address_2": "SUITE 204",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751506306",
"telephone_number": "972-686-1777",
"fax_number": "972-686-7330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2540 N GALLOWAY AVE",
"address_2": "SUITE 204",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751506306",
"telephone_number": "972-686-1777",
"fax_number": "972-686-7330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIBLAWI",
"first_name": "ISAM",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "F-5605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.