MEDICARE: GREENVILLE MEDICAL CLINIC LLC

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	207R00000X	Internal Medicine Physician	L9612	TX

General Provider Information

NPI Number	:	1972015337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	6516 JAMESTOWN RD
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-0399
Country	:	US
Telephone Number	:	214-717-8113
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MEDICAL CENTER DR STE 200
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-1769
Country	:	US
Telephone Number	:	214-717-8119
Fax Number	:	469-930-0197

Authorized Official
Title or Position	:	OWNER
Name	:	SYED MUNIR AZIZ
Credential	:	MD
Telephone Number	:	469-886-8537

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	12/13/2017

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