Healthcare Provider Details

I. General information

NPI: 1093123085
Provider Name (Legal Business Name): IDCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 15TH ST STE 110
PLANO TX
75093-5826
US

IV. Provider business mailing address

PO BOX 251382
PLANO TX
75025-1382
US

V. Phone/Fax

Practice location:
  • Phone: 469-408-9558
  • Fax: 888-393-5922
Mailing address:
  • Phone: 469-408-9558
  • Fax: 888-393-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SRIVALLI ADARI
Title or Position: CEO
Credential: MD
Phone: 469-408-2530