Provider Demographics
NPI:1417071903
Name:SAMUEL J LISTI & MARGARET A SOWADA
Entity Type:Organization
Organization Name:SAMUEL J LISTI & MARGARET A SOWADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:SOWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-247-8391
Mailing Address - Street 1:4212 HIGH SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6628
Mailing Address - Country:US
Mailing Address - Phone:972-247-8391
Mailing Address - Fax:
Practice Address - Street 1:5909 HARRY HINES BLVD
Practice Address - Street 2:ST PAUL UNIVERSITY HOSPITAL
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6209
Practice Address - Country:US
Practice Address - Phone:972-247-8391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D934Medicare ID - Type UnspecifiedGROUP IDENTIFICATION NUMB