Provider Demographics
NPI:1659436632
Name:BABICH, MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:BABICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N BUCKNER BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3400
Mailing Address - Country:US
Mailing Address - Phone:214-660-0777
Mailing Address - Fax:877-631-1566
Practice Address - Street 1:12610 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228
Practice Address - Country:US
Practice Address - Phone:469-441-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1754213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176120701Medicaid
TXP00697605OtherRAIL ROAD MEDICARE INDIVIDUAL PROVIDER #
TX5600520001Medicare NSC
TXP00697605OtherRAIL ROAD MEDICARE INDIVIDUAL PROVIDER #
TX176120701Medicaid