Healthcare Provider Details

I. General information

NPI: 1326538505
Provider Name (Legal Business Name): CHIPPEWA MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 SAN JACINTO PL
PLANO TX
75024-3233
US

IV. Provider business mailing address

17742 PRESTON RD
DALLAS TX
75252-6199
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-7246
  • Fax: 469-214-9985
Mailing address:
  • Phone: 214-975-3960
  • Fax: 469-214-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: AKASH JAIN
Title or Position: CEO
Credential:
Phone: 214-975-3960