Provider Demographics
NPI:1710323019
Name:KATHLEEN M BYNUM, DO, PA
Entity Type:Organization
Organization Name:KATHLEEN M BYNUM, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-823-6762
Mailing Address - Street 1:PO BOX 720953
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75372-0953
Mailing Address - Country:US
Mailing Address - Phone:214-823-6762
Mailing Address - Fax:
Practice Address - Street 1:5323 MILLER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6422
Practice Address - Country:US
Practice Address - Phone:214-823-6762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center