Provider Demographics
NPI:1043405467
Name:PLANO INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:PLANO INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-981-8345
Mailing Address - Street 1:6300 W PARKER RD
Mailing Address - Street 2:STE 220
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-981-8215
Mailing Address - Fax:972-981-8038
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:STE 220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-8215
Practice Address - Fax:972-981-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00055FMedicare UPIN