Healthcare Provider Details

I. General information

NPI: 1063013241
Provider Name (Legal Business Name): PLANO IVF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 W. PARKER ROAD MOB-2, SUITE G26
PLANO TX
75093
US

IV. Provider business mailing address

5477 GLEN LAKES DR STE 200
DALLAS TX
75231-4381
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-5965
  • Fax: 214-363-0639
Mailing address:
  • Phone: 214-363-5965
  • Fax: 214-363-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL J CHANTILIS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 214-363-5965