| NPI | 1245682384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHUBHA PREMNATH SHETTY Md 972-904-7683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX n4096) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TX N4096) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-08-08 |