Provider Demographics
NPI:1700836939
Name:PEDICARE MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:PEDICARE MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-608-2688
Mailing Address - Street 1:3100 MIDWAY RD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6114
Mailing Address - Country:US
Mailing Address - Phone:972-608-2688
Mailing Address - Fax:972-608-0383
Practice Address - Street 1:3100 MIDWAY RD
Practice Address - Street 2:SUITE 168
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6114
Practice Address - Country:US
Practice Address - Phone:972-608-2688
Practice Address - Fax:972-608-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty