# MD TRUCARE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043754526
- **Authorized official:** DR. AYESHA EBRAHIM (CEO)
- **Authorized official phone:** (218) 205-0198

## Contact information

- **Practice address:** 823 IRA E WOODS AVE STE 200, GRAPEVINE, TX 76051-4096
- **Practice address phone:** (817) 722-6078
- **Practice address fax:** (817) 722-6077
- **Mailing address:** PO BOX 93685, SOUTHLAKE, TX 76092-0116
- **Mailing address phone:** (218) 205-0198
- **Mailing address fax:** (817) 722-6077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 12/19/2016
- **Last updated:** 03/04/2022