Healthcare Provider Details

I. General information

NPI: 1538862131
Provider Name (Legal Business Name): TADLOCK PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 W PLANO PKWY
PLANO TX
75093-4821
US

IV. Provider business mailing address

3004 COMMUNICATIONS PKWY STE 200-304
PLANO TX
75093-8909
US

V. Phone/Fax

Practice location:
  • Phone: 214-618-8503
  • Fax: 214-618-0859
Mailing address:
  • Phone: 214-390-7697
  • Fax: 972-432-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEEL HAQ
Title or Position: OWNER
Credential: MD
Phone: 214-390-7697