Provider Demographics
NPI:1164600920
Name:IWU, PASCHAL M
Entity Type:Individual
Prefix:MR
First Name:PASCHAL
Middle Name:M
Last Name:IWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13510 TI BLVD
Mailing Address - Street 2:106C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1453
Mailing Address - Country:US
Mailing Address - Phone:972-792-7855
Mailing Address - Fax:972-792-7885
Practice Address - Street 1:13510 TI BLVD
Practice Address - Street 2:106C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1453
Practice Address - Country:US
Practice Address - Phone:972-792-7855
Practice Address - Fax:972-792-7885
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0098376332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies