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General NPI Number Information
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NPI Number | 1548752850
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Entity Type | Organization
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Legal Business Name | SUSAN BACSIK DO PLLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 730 N BISHOP AVE
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City | DALLAS
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State | TX
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Zip | 75208-4338
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Country | US
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Telephone | 817-946-0790
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Fax |
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Provider Business Mailing Address
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Address Line | 709 HAINES AVE
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City | DALLAS
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State | TX
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Zip | 75208-4032
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Country | US
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Telephone | 817-946-0790
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN LEIGH BACSIK
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Credential | DO
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Telephone | 817-946-0790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M6511
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License Number State | TX
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