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General NPI Number Information
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NPI Number | 1922544592
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Entity Type | Organization
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Legal Business Name | MEDINA PRIMARY CARE PLLC
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 4013 14TH ST 401
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City | PLANO
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State | TX
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Zip | 75074-7125
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Country | US
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Telephone | 972-456-9292
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Fax | 972-456-9393
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Provider Business Mailing Address
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Address Line | 4013 14TH ST 401
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City | PLANO
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State | TX
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Zip | 75074-7125
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Country | US
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Telephone | 972-456-9292
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Fax | 972-456-9393
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Authorized Official
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Title or Position | PHYSICAN OWNER
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Name | MIR MAJID ALI
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Credential | MD
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Telephone | 972-456-9292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | Q6929
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License Number State | TX
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