Provider Demographics
NPI:1063858629
Name:CORVINUS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CORVINUS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-271-4551
Mailing Address - Street 1:3413 DILLON CT
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-6047
Mailing Address - Country:US
Mailing Address - Phone:817-271-4551
Mailing Address - Fax:
Practice Address - Street 1:4100 HERITAGE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5714
Practice Address - Country:US
Practice Address - Phone:817-271-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty