Provider Demographics
NPI:1679706220
Name:MI FAMILIA MEDICAL, PLLC
Entity Type:Organization
Organization Name:MI FAMILIA MEDICAL, PLLC
Other - Org Name:MI FAMILIA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:VENTIMIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-253-2402
Mailing Address - Street 1:4901 LBJ FREEWAY
Mailing Address - Street 2:200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6158
Mailing Address - Country:US
Mailing Address - Phone:214-253-2402
Mailing Address - Fax:
Practice Address - Street 1:11000 GARLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2615
Practice Address - Country:US
Practice Address - Phone:972-331-1922
Practice Address - Fax:972-331-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA5274OtherMEDICARE GROUP
TXOA5790OtherMEDICARE GROUP