Provider Demographics
NPI:1114052362
Name:ADVANCED COMPREHENSIVE MEDICAL P.A.
Entity Type:Organization
Organization Name:ADVANCED COMPREHENSIVE MEDICAL P.A.
Other - Org Name:ADVANCED COMPREHENSIVE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAFIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-424-4243
Mailing Address - Street 1:832 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 300 A
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4635
Mailing Address - Country:US
Mailing Address - Phone:972-424-4243
Mailing Address - Fax:972-424-6211
Practice Address - Street 1:832 W SPRING CREEK PKWY
Practice Address - Street 2:STE 300 A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4635
Practice Address - Country:US
Practice Address - Phone:972-424-4243
Practice Address - Fax:972-424-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003KYOtherBLUE CROSS BLUE SHIELD
TX0003KYOtherBCBS OF TX