Provider Demographics
NPI:1689155830
Name:SPIKE ANESTHESIA PLLC
Entity Type:Organization
Organization Name:SPIKE ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:GHALAMBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-872-8408
Mailing Address - Street 1:5999 CUSTER ROAD, SUITE 110 #523
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9304
Mailing Address - Country:US
Mailing Address - Phone:972-872-8408
Mailing Address - Fax:
Practice Address - Street 1:7000 PRESTON RD STE 1200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2512
Practice Address - Country:US
Practice Address - Phone:972-872-8408
Practice Address - Fax:972-850-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty