Healthcare Provider Details

I. General information

NPI: 1659436632
Provider Name (Legal Business Name): MATTHEW BABICH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 E NORTHWEST HWY
DALLAS TX
75228
US

IV. Provider business mailing address

1151 N BUCKNER BLVD STE 201
DALLAS TX
75218-3400
US

V. Phone/Fax

Practice location:
  • Phone: 469-441-4484
  • Fax:
Mailing address:
  • Phone: 214-660-0777
  • Fax: 877-631-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: