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Organization
MD TRUCARE PA
Active
Organization
MD TRUCARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AYESHA EBRAHIM (CEO)
(218) 205-0198
Entity
Organization
Contact information
Practice address
823 IRA E WOODS AVE STE 200, GRAPEVINE, TX 76051-4096
(817) 722-6078
(817) 722-6077
Mailing address
PO BOX 93685, SOUTHLAKE, TX 76092-0116
(218) 205-0198
(817) 722-6077
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
12/19/2016
Last updated
03/04/2022
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