MEDICARE: MEN'S MEDICAL AND WELLNESS, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1407351604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEN'S MEDICAL AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	5301 W SPRING CREEK PKWY APT 2234
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-4912
Country	:	US
Telephone Number	:	940-781-8642
Fax Number	:	469-931-0712

Provider Business Practice Location Address
First Line	:	3013 E RENNER RD STE 120
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3577
Country	:	US
Telephone Number	:	469-931-0684
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	TIM MCAULIFF
Credential	:	MD
Telephone Number	:	469-931-0684

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	09/22/2021

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