Provider Demographics
NPI:1083978514
Name:IMAGE RESTORATION P A
Entity Type:Organization
Organization Name:IMAGE RESTORATION P A
Other - Org Name:MOUNIR MEKHAIL, MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-499-1535
Mailing Address - Street 1:4112 RYAN LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3752
Mailing Address - Country:US
Mailing Address - Phone:214-499-1535
Mailing Address - Fax:972-957-2640
Practice Address - Street 1:4112 RYAN LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3752
Practice Address - Country:US
Practice Address - Phone:214-499-1535
Practice Address - Fax:972-957-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2154207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025HSOtherBCBS
TXTXB161305Medicare PIN