Provider Demographics
NPI:1871772749
Name:KIZILBASH, QURATULAIN FATIMA (MD, MPH)
Entity type:Individual
Prefix:
First Name:QURATULAIN
Middle Name:FATIMA
Last Name:KIZILBASH
Suffix:
Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-778-5334
Mailing Address - Fax:404-778-5495
Practice Address - Street 1:2303 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:210-618-1097
Practice Address - Fax:210-531-4508
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA059808208M00000X
TXP4474207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCHTRMedicare PIN