Healthcare Provider Details

I. General information

NPI: 1215208905
Provider Name (Legal Business Name): AJK MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 HILLCREST PLAZA DR SUITE 215
DALLAS TX
75230-1400
US

IV. Provider business mailing address

6750 HILLCREST PLAZA DR SUITE 215
DALLAS TX
75230-1400
US

V. Phone/Fax

Practice location:
  • Phone: 972-690-0550
  • Fax: 972-690-3306
Mailing address:
  • Phone: 972-690-0550
  • Fax: 972-690-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberK8265
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberK8265
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberK8265
License Number StateTX

VIII. Authorized Official

Name: DR. ANDREW MICHAEL KLYMIUK
Title or Position: OWNER
Credential: M.D.
Phone: 972-690-0550