Provider Demographics
NPI:1326538505
Name:CHIPPEWA MEDICAL PLLC
Entity Type:Organization
Organization Name:CHIPPEWA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-975-3960
Mailing Address - Street 1:17742 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6199
Mailing Address - Country:US
Mailing Address - Phone:214-975-3960
Mailing Address - Fax:469-214-9985
Practice Address - Street 1:7504 SAN JACINTO PL
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3233
Practice Address - Country:US
Practice Address - Phone:972-769-7246
Practice Address - Fax:469-214-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty