MEDICARE: DR. SIRINE A BALTAGI MD

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	208000000X	Pediatrics Physician	2012014536	MO
2	208000000X	Pediatrics Physician	S3947	TX
3	2080P0203X	Pediatric Critical Care Medicine Physician	S3947	TX
4	2080P0203X	Pediatric Critical Care Medicine Physician	2012014536	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891976486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIRINE A BALTAGI MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-730-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-1002
Country	:	US
Telephone Number	:	214-730-5437
Fax Number	:

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

Provider Enumeration Date	:	11/25/2007
Last Update Date	:	11/23/2020

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Directions to “ DR. SIRINE A BALTAGI MD” Practice Location

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