Provider Demographics
NPI:1144567637
Name:CWIDA INC
Entity Type:Organization
Organization Name:CWIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FOJTASEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-239-3849
Mailing Address - Street 1:15800 DOOLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4284
Mailing Address - Country:US
Mailing Address - Phone:972-239-3849
Mailing Address - Fax:866-292-6489
Practice Address - Street 1:15800 DOOLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4284
Practice Address - Country:US
Practice Address - Phone:972-239-3849
Practice Address - Fax:866-292-6489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty