Healthcare Provider Details

I. General information

NPI: 1669291035
Provider Name (Legal Business Name): METROPLEX PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 WARREN PKWY STE 101
FRISCO TX
75034-4165
US

IV. Provider business mailing address

7668 ELDORADO PKWY STE 200
MCKINNEY TX
75070-5753
US

V. Phone/Fax

Practice location:
  • Phone: 214-762-9084
  • Fax:
Mailing address:
  • Phone: 214-762-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PRAKASH KRISHNARAJ
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-762-9084