MEDICARE: RESTORE BRAIN, 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
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician		TX

General Provider Information

NPI Number	:	1154839470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE BRAIN, PLLC

Provider Business Mailing Address
First Line	:	4643 WESTGROVE DR
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3216
Country	:	US
Telephone Number	:	214-562-6364
Fax Number	:	888-990-0663

Provider Business Practice Location Address
First Line	:	2800 SHORELINE DR # 220
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0128
Country	:	US
Telephone Number	:	888-990-0663
Fax Number	:	888-990-0663

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DAVID CICHY
Credential	:
Telephone Number	:	214-562-6364

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	12/10/2025

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