Healthcare Provider Details
I. General information
NPI: 1275294894
Provider Name (Legal Business Name): MERGE HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/05/2022
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
12801 N CENTRAL EXPY STE 400
DALLAS TX
75243-1716
US
IV. Provider business mailing address
12801 N CENTRAL EXPY STE 400
DALLAS TX
75243-1716
US
V. Phone/Fax
- Phone: 972-905-1664
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208100000X |
| Taxonomy | Physical Medicine & Rehabilitation Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207X00000X |
| Taxonomy | Orthopaedic Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ANDREW
INDRESANO
Title or Position: PHYSICIAN
Credential: MD
Phone: 612-202-0179