Islam, Ebtesam
Islam, Ebtesam is an individual health care provider with primary practice located at 3601 4Th St Ms 9410, Lubbock TX 79430-9410. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pulmonary Disease, Allopathic & Osteopathic Physicians / Critical Care Medicine. Allopathic & Osteopathic Physicians / Critical Care Medicine is her primary health care specialty. Islam, Ebtesam can be contacted via phone (806) 743-3155.Contact Information
Primary practice address
3601 4Th St Ms 9410
Lubbock TX 79430-9410
Phone: (806) 743-3155
Fax: (806) 743-3143
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | R0253 | Texas |
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | R0253 | Texas |
Profile Details
| NPI number | 1710208913 |
|---|---|
| LBN Legal business name | Islam, Ebtesam |
| Credentials | M.D., PH.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 22nd, 2010 |
| Last updated | Nov 10th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710208913 | NPPES |
| Texas | MEDICAID | 363703501 |
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