Provider Demographics
NPI:1245418219
Name:MARK CWIKLA, MD PA
Entity Type:Organization
Organization Name:MARK CWIKLA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-259-4768
Mailing Address - Street 1:7301 N STATE HWY 161
Mailing Address - Street 2:STE 160
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2811
Mailing Address - Country:US
Mailing Address - Phone:972-259-4768
Mailing Address - Fax:972-254-9640
Practice Address - Street 1:7301 N STATE HWY 161
Practice Address - Street 2:STE 160
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2811
Practice Address - Country:US
Practice Address - Phone:972-259-4768
Practice Address - Fax:972-254-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3878174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114457802Medicaid
TXOA3689Medicare PIN
TX114457802Medicaid
TX00DF57Medicare PIN