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General NPI Number Information
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NPI Number | 1952754806
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Entity Type | Organization
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Legal Business Name | MEDBAK HEALTHCARE SERVICES, PLLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 1130 BEACHVIEW ST STE 110
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 214-516-1495
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Fax | 214-660-8634
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Provider Business Mailing Address
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Address Line | 1130 BEACHVIEW ST STE 110
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 214-516-1495
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ADEWUMI BAKARE
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Credential | PA
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Telephone | 214-516-1495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06380
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License Number State | TX
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