MEDICARE: MEDICAL ASSOCIATES OF DALLAS 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1336799618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ASSOCIATES OF DALLAS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 794564
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75379-4564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6380 LBJ FWY STE 290
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6416
Country	:	US
Telephone Number	:	972-991-1153
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	GHOLAMREZA ASSADOLLAH
Credential	:	FNP
Telephone Number	:	469-503-1916

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	01/27/2026

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