MEDICARE: IROQUOIS MEDICAL PLLC

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1992295125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IROQUOIS MEDICAL PLLC

Provider Business Mailing Address
First Line	:	17742 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-6199
Country	:	US
Telephone Number	:	214-975-3960
Fax Number	:	214-975-3961

Provider Business Practice Location Address
First Line	:	7504 SAN JACINTO PL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3233
Country	:	US
Telephone Number	:	214-975-3960
Fax Number	:	469-214-9985

Authorized Official
Title or Position	:	CEO
Name	:	AKASH JAIN
Credential	:
Telephone Number	:	214-975-3960

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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