Provider Demographics
NPI:1083705362
Name:ENDELMAN, IRWIN (MD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:ENDELMAN
Suffix:
Gender:M
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 1969
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1903
Mailing Address - Country:US
Mailing Address - Phone:972-981-7927
Mailing Address - Fax:972-981-7928
Practice Address - Street 1:6130 W. PARKER RD
Practice Address - Street 2:MOB 1 STE 310
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-981-7927
Practice Address - Fax:972-981-7928
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106357003Medicaid