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NPI Code Detail

MEDICARE: INNATE MEDICAL SOLUTIONS PLLC

MEDICARE: INNATE MEDICAL SOLUTIONS 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
1208600000XSurgery Physician

General Provider Information

NPI Number : 1154025252
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNATE MEDICAL SOLUTIONS PLLC
Provider Business Mailing Address
First Line : 7504 SAN JACINTO PL
Second Line :
City : PLANO
State : TX
Zip : 75024-3233
Country : US
Telephone Number : 972-789-1234
Fax Number :
Provider Business Practice Location Address
First Line : 17218 PRESTON RD STE 2150
Second Line :
City : DALLAS
State : TX
Zip : 75252-4018
Country : US
Telephone Number : 972-789-1234
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : GARY DEWAYNE MARTIN
Credential : DC
Telephone Number : 972-788-9123
Provider Enumeration Date : 03/30/2023
Last Update Date : 03/30/2023

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Directions to “INNATE MEDICAL SOLUTIONS PLLC ” Practice Location

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