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General NPI Number Information
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NPI Number | 1649093832
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Entity Type | Organization
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Legal Business Name | IDMDTX, PLLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1307 8TH AVE STE 306
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City | FORT WORTH
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State | TX
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Zip | 76104-4140
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Country | US
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Telephone | 813-943-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 4843 COLLEYVILLE BLVD # 251-103
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City | COLLEYVILLE
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State | TX
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Zip | 76034-3923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MILONI SHROFF
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Credential |
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Telephone | 813-943-2570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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