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NPI Code Detail

MEDICARE: ALLIED INSTITUTE OF MEDICINE, PLLC

MEDICARE: ALLIED INSTITUTE OF MEDICINE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianK3819TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10060EVOTHERTXBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023028669
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLIED INSTITUTE OF MEDICINE, PLLC
Provider Business Mailing Address
First Line : 4360 GRECO DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78222-2725
Country : US
Telephone Number : 210-648-8200
Fax Number : 210-648-8204
Provider Business Practice Location Address
First Line : 4360 GRECO DR.
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78222-2725
Country : US
Telephone Number : 210-648-8200
Fax Number : 210-648-8204
Authorized Official
Title or Position : CEO
Name : DAVID HO SUNG PAK
Credential : D.O.
Telephone Number : 210-648-8200
Provider Enumeration Date : 08/08/2006
Last Update Date : 11/01/2010

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Directions to “ALLIED INSTITUTE OF MEDICINE, PLLC ” Practice Location

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