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General NPI Number Information
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NPI Number | 1437912433
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Entity Type | Organization
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Legal Business Name | OLD MCDONALD HEALTH CARE SERVICES PA
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 4300 PUNJAB WAY STE 160
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City | FRISCO
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State | TX
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Zip | 75033-0382
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Country | US
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Telephone | 469-649-9968
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Fax | 469-649-9969
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Provider Business Mailing Address
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Address Line | PO BOX 140306
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City | IRVING
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State | TX
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Zip | 75014-0306
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Country | US
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Telephone | 469-649-9968
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Fax | 469-649-9969
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Authorized Official
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Title or Position | OWNER
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Name | HARISH NUTHAKKI
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Credential | MD
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Telephone | 810-513-7501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 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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