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General NPI Number Information
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NPI Number | 1336654607
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Entity Type | Organization
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Legal Business Name | DALLAS INTERNAL MEDICINE AND GERIATRIC SPECIALISTS PLLC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 601 CLARA BARTON BLVD # 145
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City | GARLAND
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State | TX
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Zip | 75042
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Country | US
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Telephone | 972-560-9400
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Fax | 975-560-9401
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Provider Business Mailing Address
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Address Line | 9330 LBJ FWY STE 800
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City | DALLAS
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State | TX
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Zip | 75243-4310
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Country | US
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Telephone | 972-792-5700
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Fax | 214-506-1170
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Authorized Official
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Title or Position | COO
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Name | AMY GOLISZEK
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Credential |
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Telephone | 214-506-2617
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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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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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