Healthcare Provider Details

I. General information

NPI: 1740472299
Provider Name (Legal Business Name): NTKC MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 ALLIANCE BLVD SUITE 600
PLANO TX
75093-5340
US

IV. Provider business mailing address

3030 MATLOCK RD SUITE 205
ARLINGTON TX
76015-2935
US

V. Phone/Fax

Practice location:
  • Phone: 469-467-0011
  • Fax: 469-467-4923
Mailing address:
  • Phone: 817-375-0610
  • Fax: 817-375-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAN BACCUS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 817-375-0610