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General NPI Number Information
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NPI Number | 1154611044
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Entity Type | Organization
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Legal Business Name | IRWIN S. KORNGUT MDPA
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 8220 WALNUT HILL LN SUITE 110
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City | DALLAS
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State | TX
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Zip | 75231-4427
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Country | US
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Telephone | 214-739-5505
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Fax | 214-987-3194
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Provider Business Mailing Address
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Address Line | 8220 WALNUT HILL LN SUITE 110
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City | DALLAS
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State | TX
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Zip | 75231-4427
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Country | US
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Telephone | 214-739-5505
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Fax | 214-987-3194
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Authorized Official
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Title or Position | PRWSIDENT
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Name | DR. IRWIN S KORNGUT
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Credential | M.D.
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Telephone | 214-739-5505
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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 | E9753
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License Number State | TX
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