Provider Demographics
NPI:1073608667
Name:SOLODKY, INNA (MD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:SOLODKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:3501 MILLS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6309
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-324-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0281207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210700507Medicaid
TN0028MHOtherBLUE CROSS
TX210700508Medicaid
TX210700508Medicaid
TX295650YKXVMedicare PIN
TX210700507Medicaid
TXH58612Medicare UPIN