MEDICARE: DR. ELLIOT J GINCHANSKY 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	207K00000X	Allergy & Immunology Physician	E4847	TX

General Provider Information

NPI Number	:	1962401471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT J GINCHANSKY M.D.

Provider Business Mailing Address
First Line	:	6912 LA MANGA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-2908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN
Second Line	:	SUITE C530
City	:	DALLAS
State	:	TX
Zip	:	75230-2505
Country	:	US
Telephone Number	:	972-566-7576
Fax Number	:	972-566-6177

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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