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General NPI Number Information
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NPI Number | 1003302944
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Entity Type | Organization
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Legal Business Name | AMK PROVIDER SOLUTIONS PLLC
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 8197 MIDTOWN BLVD APT 15101
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City | DALLAS
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State | TX
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Zip | 75231-4566
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Country | US
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Telephone | 312-810-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 8197 MIDTOWN BLVD APT 15101
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City | DALLAS
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State | TX
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Zip | 75231-4566
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Country | US
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Telephone | 312-810-8105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY KALVAITIS
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Credential | PA
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Telephone | 312-810-8105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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