MEDICARE: JOHN MICHAEL DESALOMS M.D.

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	207T00000X	Neurological Surgery Physician	J5562	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699761510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MICHAEL DESALOMS M.D.

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	STE 220
City	:	DALLAS
State	:	TX
Zip	:	75231-4482
Country	:	US
Telephone Number	:	214-750-3646
Fax Number	:	214-363-2351

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	STE 220
City	:	DALLAS
State	:	TX
Zip	:	75231-4482
Country	:	US
Telephone Number	:	214-750-3646
Fax Number	:	214-363-2351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	06/24/2014

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