Provider Demographics
NPI:1578938544
Name:PODIATRIC MEDICAL PARTNERS OF TEXAS, PA
Entity Type:Organization
Organization Name:PODIATRIC MEDICAL PARTNERS OF TEXAS, PA
Other - Org Name:JONATHAN M KLETZ, DPM PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALPERIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-330-9299
Mailing Address - Street 1:801 N ZANG BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4858
Mailing Address - Country:US
Mailing Address - Phone:214-330-9299
Mailing Address - Fax:866-846-5648
Practice Address - Street 1:166 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3712
Practice Address - Country:US
Practice Address - Phone:903-887-4341
Practice Address - Fax:903-887-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6343320034Medicare NSC