Healthcare Provider Details

I. General information

NPI: 1992824890
Provider Name (Legal Business Name): GEORGE NIEMIROWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E RANDOL MILL RD
ARLINGTON TX
76011-8217
US

IV. Provider business mailing address

2100 E RANDOL MILL RD
ARLINGTON TX
76011-8217
US

V. Phone/Fax

Practice location:
  • Phone: 817-261-5166
  • Fax: 817-275-5432
Mailing address:
  • Phone: 817-261-5166
  • Fax: 817-275-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberH0686
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: