| Restoredoc Md | |
|
3910 Gaston Ave Ste 140 Dallas TX 75246-1523 | |
| (214) 494-8121 | |
| (972) 707-0702 |
| Full Name | Restoredoc Md |
|---|---|
| Speciality | Clinic/Center |
| Location | 3910 Gaston Ave Ste 140, Dallas, Texas |
| Authorized Official Name and Position | Bob Olovsson (OWNER) |
| Authorized Official Contact | 7149558695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoredoc Md 3910 Gaston Ave Ste 140 Dallas TX 75246-1523 Ph: (214) 494-8121 | Restoredoc Md 3910 Gaston Ave Ste 140 Dallas TX 75246-1523 Ph: (214) 494-8121 |
| NPI Number | 1922542075 |
|---|---|
| Provider Enumeration Date | 12/08/2016 |
| Last Update Date | 03/25/2021 |
| Medicare PECOS PAC ID | 2668803438 |
|---|---|
| Medicare Enrollment ID | O20200511002845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922542075 | NPI | - | NPPES |
| 1922542075 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Julio C Olivieri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881605780 PECOS PAC ID: 4587667555 Enrollment ID: I20060811000089 |
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