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NPI Code Detail

MEDICARE: AMANDA SIEWERT TCHAKAROV M.D.

MEDICARE: AMANDA SIEWERT TCHAKAROV M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianQ0190TX

General Provider Information

NPI Number : 1720343965
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA SIEWERT TCHAKAROV M.D.
Provider Business Mailing Address
First Line : 1935 MEDICAL CENTER DRIVE
Second Line :
City : DALLAS
State : TX
Zip : 75235-7323
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1935 MEDICAL DISTRICT DR
Second Line :
City : DALLAS
State : TX
Zip : 75235-7701
Country : US
Telephone Number : 214-786-1249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2012
Last Update Date : 07/29/2015

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