Healthcare Provider Details

I. General information

NPI: 1962901538
Provider Name (Legal Business Name): ID DOCS OF DALLAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 04/17/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WEST SPRING CREEK PKWY SUITE 400
PLANO TX
75021-5331
US

IV. Provider business mailing address

611 OAK GROVE LN
COPPELL TX
75019-2407
US

V. Phone/Fax

Practice location:
  • Phone: 972-737-8299
  • Fax:
Mailing address:
  • Phone: 732-216-6273
  • Fax: 469-969-0048

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: SHEETHAL M LAXMI
Title or Position: OWNER
Credential: MN
Phone: 732-216-6273