=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750144770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALNUT HILL ENT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2024
-----------------------------------------------------
Last Update Date | 02/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8210 WALNUT HILL LN BUILDING 1, SUITE 408
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-647-1836
-----------------------------------------------------
Fax | 214-468-4000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8210 WALNUT HILL LN BUILDING 1, SUITE 408
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-647-1836
-----------------------------------------------------
Fax | 214-468-4000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INITIAL MEMBER
-----------------------------------------------------
Name | DR. HENRI C TANNAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-647-1836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------