MEDICARE: BLG GROUP INC

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	G2144	TX

General Provider Information

NPI Number	:	1871732594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLG GROUP INC

Provider Business Mailing Address
First Line	:	2351 W NORTHWEST HWY STE 2235
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-674-7052
Fax Number	:	214-593-2913

Provider Business Practice Location Address
First Line	:	2351 W NORTHWEST HWY STE 2235
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-674-7052
Fax Number	:	214-593-2913

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN LESLIE GWARTZ
Credential	:	MD
Telephone Number	:	214-674-7052

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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Directions to “BLG GROUP INC ” Practice Location

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