| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 17610 Preston Rd, Dallas, Texas |
| Authorized Official Name and Position | Hania Alaidroos (PRESIDENT) |
| Authorized Official Contact | 9729310100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
17610 Preston Rd Dallas TX 75252-5734 Ph: (972) 931-0100 | 17610 Preston Rd Dallas TX 75252 Ph: (972) 931-0100 |
| NPI Number | 1164646931 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 08/13/2018 |
| Medicare PECOS PAC ID | 2264533710 |
|---|---|
| Medicare Enrollment ID | O20070727000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164646931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L9058 (Texas) | Primary |
| Provider Name | Hania Alaidroos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205826112 PECOS PAC ID: 9436101425 Enrollment ID: I20050217000909 |
| Provider Name | Risha Kopel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548311160 PECOS PAC ID: 5395049720 Enrollment ID: I20180102000279 |
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