MEDICARE: NEUROLOGY DIAGNOSTIC CENTERS OF DALLAS INC

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	174400000X	Specialist	K6814	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	:	1750478913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY DIAGNOSTIC CENTERS OF DALLAS INC

Provider Business Mailing Address
First Line	:	9301 N CENTRAL EXPY
Second Line	:	STE 585
City	:	DALLAS
State	:	TX
Zip	:	75231-0811
Country	:	US
Telephone Number	:	214-363-3623
Fax Number	:	214-363-0869

Provider Business Practice Location Address
First Line	:	9301 N CENTRAL EXPY
Second Line	:	STE 585
City	:	DALLAS
State	:	TX
Zip	:	75231-0811
Country	:	US
Telephone Number	:	214-363-3623
Fax Number	:	214-363-0869

Authorized Official
Title or Position	:	OWNER
Name	:	ZIAD A BLAIK
Credential	:	M.D.
Telephone Number	:	214-363-3623

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	09/04/2012

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