Healthcare Provider Details

I. General information

NPI: 1760147490
Provider Name (Legal Business Name): PRIMARY CARE DOCTORS OF NORTH TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 LAKE RIDGE PKWY STE 148
GRAND PRAIRIE TX
75052-3000
US

IV. Provider business mailing address

4927 LAKE RIDGE PKWY STE 148
GRAND PRAIRIE TX
75052-3000
US

V. Phone/Fax

Practice location:
  • Phone: 972-217-4203
  • Fax: 833-784-1531
Mailing address:
  • Phone: 972-217-4203
  • Fax: 833-784-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHAITANYA CHAVDA
Title or Position: MANAGER
Credential: MD
Phone: 313-505-2932