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General NPI Number Information
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NPI Number | 1073159208
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Entity Type | Organization
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Legal Business Name | MEDPROFESSIONAL CONSULT LLC
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 5242 MEDICAL DR
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City | ROCKWALL
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State | TX
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Zip | 75032-5001
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Country | US
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Telephone | 972-772-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 RIVERSIDE OAKS DR
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City | ROCKWALL
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State | TX
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Zip | 75087-2425
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Country | US
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Telephone | 414-793-5659
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Fax |
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Authorized Official
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Title or Position | DO/OWNER
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Name | DR. MARIANA TAWADROUS
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Credential | DO
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Telephone | 414-793-5659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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