Healthcare Provider Details

I. General information

NPI: 1952678815
Provider Name (Legal Business Name): LUMIN HEALTH PHYSICIAN GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N MACARTHUR BLVD STE 101
IRVING TX
75038-6497
US

IV. Provider business mailing address

4301 N MACARTHUR BLVD STE 101
IRVING TX
75038-6497
US

V. Phone/Fax

Practice location:
  • Phone: 972-573-7822
  • Fax: 972-255-6688
Mailing address:
  • Phone: 972-573-7822
  • Fax: 972-255-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS S WON
Title or Position: OWNER
Credential: MD
Phone: 972-255-5588