Provider Demographics
NPI:1164646931
Name:ALLIANCE FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:ALLIANCE FAMILY MEDICINE PA
Other - Org Name:ARBOR GREEN FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAIDROOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-931-0100
Mailing Address - Street 1:17610 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5734
Mailing Address - Country:US
Mailing Address - Phone:972-931-0100
Mailing Address - Fax:972-931-0400
Practice Address - Street 1:17610 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252
Practice Address - Country:US
Practice Address - Phone:972-931-0100
Practice Address - Fax:972-931-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty