Provider Demographics
NPI:1093123085
Name:IDCARE, PLLC
Entity Type:Organization
Organization Name:IDCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SRIVALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-408-2530
Mailing Address - Street 1:PO BOX 251382
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1382
Mailing Address - Country:US
Mailing Address - Phone:469-408-9558
Mailing Address - Fax:888-393-5922
Practice Address - Street 1:4100 W 15TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5826
Practice Address - Country:US
Practice Address - Phone:469-408-9558
Practice Address - Fax:888-393-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty