Provider Demographics
NPI:1003940388
Name:FAGADAU & HAWK, M.D LLP
Entity Type:Organization
Organization Name:FAGADAU & HAWK, M.D LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-987-2020
Mailing Address - Street 1:6131 LUTHER LN STE 216
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225
Mailing Address - Country:US
Mailing Address - Phone:214-987-2020
Mailing Address - Fax:214-739-3725
Practice Address - Street 1:6131 LUTHER LN STE 216
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:214-987-2020
Practice Address - Fax:214-739-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1145005-03Medicaid
TX1104887-02Medicaid
TX00DW54Medicare ID - Type UnspecifiedDR. HAWK
TXB22603Medicare UPIN
TX1104887-02Medicaid
TXC16710Medicare UPIN