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General NPI Number Information
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NPI Number | 1679341267
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Entity Type | Organization
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Legal Business Name | DIABETIC CARE LLC
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 1600 LANCASTER DR STE 102
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City | GRAPEVINE
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State | TX
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Zip | 76051-3579
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Country | US
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Telephone | 817-481-4000
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Fax | 877-294-5802
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Provider Business Mailing Address
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Address Line | 2807 ALLEN ST STE 2210
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City | DALLAS
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State | TX
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Zip | 75204-1031
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Country | US
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Telephone | 817-481-4000
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Fax | 877-294-5802
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MICHAEL BINGHAM
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Credential |
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Telephone | 817-564-2414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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