Provider Demographics
NPI:1003821679
Name:ALLIED GROUP MD PA
Entity Type:Organization
Organization Name:ALLIED GROUP MD PA
Other - Org Name:MED CENTRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/TREATING DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-637-3737
Mailing Address - Street 1:7203 JOHN W CARPENTER FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-5113
Mailing Address - Country:US
Mailing Address - Phone:214-637-3737
Mailing Address - Fax:214-637-7014
Practice Address - Street 1:7203 JOHN W CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5113
Practice Address - Country:US
Practice Address - Phone:214-637-3737
Practice Address - Fax:214-637-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9876111N00000X
TX8197111N00000X
TX8046111N00000X
TX7015111N00000X
TX9851111N00000X
TX9551111N00000X
TX2592111N00000X
TXE5382207RC0000X
TXH3034208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty