Provider Demographics
NPI:1063013241
Name:PLANO IVF LLC
Entity Type:Organization
Organization Name:PLANO IVF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHANTILIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-363-5965
Mailing Address - Street 1:5477 GLEN LAKES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4381
Mailing Address - Country:US
Mailing Address - Phone:214-363-5965
Mailing Address - Fax:214-363-0639
Practice Address - Street 1:6300 W. PARKER ROAD
Practice Address - Street 2:MOB-2, SUITE G26
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:214-363-5965
Practice Address - Fax:214-363-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty