Provider Demographics
NPI:1003144387
Name:SUNIL MATHEWS, MD PA
Entity Type:Organization
Organization Name:SUNIL MATHEWS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAILLEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3448
Mailing Address - Street 1:7701 LAS COLINAS RDG STE 260
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7554
Mailing Address - Country:US
Mailing Address - Phone:972-869-3448
Mailing Address - Fax:972-459-7729
Practice Address - Street 1:7701 LAS COLINAS RDG STE 260
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7554
Practice Address - Country:US
Practice Address - Phone:972-869-3448
Practice Address - Fax:972-459-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000553EMedicare PIN