Provider Demographics
NPI:1306025614
Name:LOUIS D ZEGARELLI D O P A
Entity Type:Organization
Organization Name:LOUIS D ZEGARELLI D O P A
Other - Org Name:KIEST PARK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ZEGARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-333-3393
Mailing Address - Street 1:2225 VATICAN LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4719
Mailing Address - Country:US
Mailing Address - Phone:214-333-3393
Mailing Address - Fax:214-333-0809
Practice Address - Street 1:2225 VATICAN LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4719
Practice Address - Country:US
Practice Address - Phone:214-333-3393
Practice Address - Fax:214-333-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146654201Medicaid
TX146654201Medicaid