MEDICARE: TEXAS INTENSIVISTS NETWORK 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	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	K1331	TX

General Provider Information

NPI Number	:	1659733400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS INTENSIVISTS NETWORK PLLC

Provider Business Mailing Address
First Line	:	1801 COTTONWOOD VALLEY CIR S
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6214
Country	:	US
Telephone Number	:	214-492-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 N MACARTHUR BLVD
Second Line	:	SUITE 122-228
City	:	IRVING
State	:	TX
Zip	:	75038-6419
Country	:	US
Telephone Number	:	214-492-1188
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ADEBOLA ADESANYA
Credential	:	MD
Telephone Number	:	214-492-1188

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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