Provider Demographics
NPI:1225745854
Name:MLD HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MLD HEALTHCARE, LLC
Other - Org Name:MD YOUR-OLOGY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-296-0782
Mailing Address - Street 1:1301 E DEBBIE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3376
Mailing Address - Country:US
Mailing Address - Phone:817-406-6864
Mailing Address - Fax:817-259-2749
Practice Address - Street 1:2833 MEADE DR APT SUITE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8344
Practice Address - Country:US
Practice Address - Phone:817-406-6864
Practice Address - Fax:817-259-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty