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General NPI Number Information
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NPI Number | 1881847861
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Entity Type | Organization
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Legal Business Name | DFW INTERNAL MEDICINE CLINIC, PLLC
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 2207 MICHIGAN AVE
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City | ARLINGTON
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State | TX
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Zip | 76013-5916
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Country | US
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Telephone | 817-465-7400
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Fax | 817-704-7057
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Provider Business Mailing Address
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Address Line | 2207 MICHIGAN AVE
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City | ARLINGTON
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State | TX
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Zip | 76013-5916
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Country | US
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Telephone | 817-465-7400
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Fax | 817-704-7057
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Authorized Official
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Title or Position | OWNER
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Name | PETUA OKOLO
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Credential | DO
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Telephone | 817-465-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M0846
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License Number State | TX
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