MEDICARE: PERIOPERATIVE AND TRANSITIONAL MEDICINE GROUP 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	207R00000X	Internal Medicine Physician	M4304	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M4304	OTHER	TX	LICENSE #
2	154232	OTHER	TX	UPIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164899639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERIOPERATIVE AND TRANSITIONAL MEDICINE GROUP PLLC

Provider Business Mailing Address
First Line	:	2108 DALLAS PKWY
Second Line	:	SUITE 214-566
City	:	PLANO
State	:	TX
Zip	:	75093-4361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	SUITE 312
City	:	DALLAS
State	:	TX
Zip	:	75231-4405
Country	:	US
Telephone Number	:	214-238-3074
Fax Number	:	214-238-3608

Authorized Official
Title or Position	:	OWNER
Name	:	JAMAL LONE I
Credential	:	MD
Telephone Number	:	214-238-3074

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	11/15/2017

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