Provider Demographics
NPI:1467082438
Name:PROLIFERATIVEMED PLLC
Entity Type:Organization
Organization Name:PROLIFERATIVEMED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-839-3777
Mailing Address - Street 1:615 W LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3848
Mailing Address - Country:US
Mailing Address - Phone:817-917-6197
Mailing Address - Fax:
Practice Address - Street 1:731 E SOUTHLAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6378
Practice Address - Country:US
Practice Address - Phone:817-917-6197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty