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General NPI Number Information
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NPI Number | 1649403106
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Entity Type | Organization
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Legal Business Name | GREGG T. PODLESKI, D.O. P.A.
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 2540 N GALLOWAY AVE SUITE 302
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City | MESQUITE
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State | TX
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Zip | 75150-6306
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Country | US
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Telephone | 972-613-7776
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Fax | 972-613-7775
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Provider Business Mailing Address
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Address Line | PO BOX 851858
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City | MESQUITE
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State | TX
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Zip | 75185-1858
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Country | US
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Telephone | 972-613-7776
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Fax | 972-613-7775
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. GREGG THOMAS PODLESKI
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Credential | D.O., P.A.
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Telephone | 972-613-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | J7138
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License Number State | TX
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