| Medical Associates Of Dallas Pllc | |
|
4601 Old Shepard Pl Ste 404 Plano TX 75093-5277 | |
| (972) 964-2626 | |
| Not Available |
| Full Name | Medical Associates Of Dallas Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4601 Old Shepard Pl Ste 404, Plano, Texas |
| Authorized Official Name and Position | Gholamreza Assadollah (SOLE MEMBER) |
| Authorized Official Contact | 4695031916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Associates Of Dallas Pllc Po Box 794564 Dallas TX 75379-4564 Ph: () - | Medical Associates Of Dallas Pllc 4601 Old Shepard Pl Ste 404 Plano TX 75093-5277 Ph: (972) 964-2626 |
| NPI Number | 1336799618 |
|---|---|
| Provider Enumeration Date | 09/18/2019 |
| Last Update Date | 10/10/2022 |
| Medicare PECOS PAC ID | 1052742210 |
|---|---|
| Medicare Enrollment ID | O20200504001637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336799618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Reza Assadollahi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356556591 PECOS PAC ID: 9739484759 Enrollment ID: I20200507002878 |
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