Healthcare Provider Details

I. General information

NPI: 1225393473
Provider Name (Legal Business Name): COLLINS STREET PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 S COLLINS ST SUITE 121
ARLINGTON TX
76018-1157
US

IV. Provider business mailing address

4907 S COLLINS ST SUITE 121
ARLINGTON TX
76018-1156
US

V. Phone/Fax

Practice location:
  • Phone: 817-417-9001
  • Fax: 817-417-9008
Mailing address:
  • Phone: 817-417-9001
  • Fax: 817-417-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHIMENE W FIKKERT
Title or Position: PHYSICIAN
Credential: DO
Phone: 817-417-9001