Provider Demographics
NPI:1407351604
Name:MEN'S MEDICAL AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:MEN'S MEDICAL AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAULIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-931-0684
Mailing Address - Street 1:5301 W SPRING CREEK PKWY APT 2234
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4912
Mailing Address - Country:US
Mailing Address - Phone:940-781-8642
Mailing Address - Fax:469-931-0712
Practice Address - Street 1:3013 E RENNER RD STE 120
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3577
Practice Address - Country:US
Practice Address - Phone:469-931-0684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty