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General NPI Number Information
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NPI Number | 1194216291
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Entity Type | Organization
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Legal Business Name | DASILVA PHYSICAL MEDICINE, PLLC
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 363 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3867
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Country | US
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Telephone | 972-436-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 14908 DEVONSHIRE LN
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City | FRISCO
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State | TX
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Zip | 75035-0648
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Country | US
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Telephone | 773-425-4468
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | OMID GHALAMBOR
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Credential | MD
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Telephone | 773-425-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TX
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