MEDICARE: DMLC MEDICAL 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1538742887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMLC MEDICAL PLLC

Provider Business Mailing Address
First Line	:	1201 RICHARDSON DR STE 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-4610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 RICHARDSON DR STE 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-4610
Country	:	US
Telephone Number	:	972-235-6311
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CAMERON OLSON
Credential	:
Telephone Number	:	972-235-6311

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	03/09/2026

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