Provider Demographics
NPI:1548752850
Name:SUSAN BACSIK DO PLLC
Entity Type:Organization
Organization Name:SUSAN BACSIK DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BACSIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-946-0790
Mailing Address - Street 1:709 HAINES AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4032
Mailing Address - Country:US
Mailing Address - Phone:817-946-0790
Mailing Address - Fax:
Practice Address - Street 1:730 N BISHOP AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4338
Practice Address - Country:US
Practice Address - Phone:817-946-0790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6511261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care