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General NPI Number Information
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NPI Number | 1619598364
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Entity Type | Organization
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Legal Business Name | KEVIN MAINZ
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 1401 SEMINOLE DR
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City | RICHARDSON
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State | TX
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Zip | 75080-3738
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Country | US
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Telephone | 972-345-2436
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 SEMINOLE DR
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City | RICHARDSON
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State | TX
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Zip | 75080-3738
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Country | US
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Telephone | 972-345-2436
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KEVIN MAINZ
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Credential |
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Telephone | 972-645-2436
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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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