Provider Demographics
NPI:1720584691
Name:DALLAS CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:DALLAS CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-924-4073
Mailing Address - Street 1:391 E. LAS COLINAS BLVD.
Mailing Address - Street 2:STE. 130 #335
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-6225
Mailing Address - Country:US
Mailing Address - Phone:972-972-4252
Mailing Address - Fax:877-277-3002
Practice Address - Street 1:560 W MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3604
Practice Address - Country:US
Practice Address - Phone:972-972-4252
Practice Address - Fax:972-972-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-01
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1610360OtherWELLCARE
TXQMP000003903277OtherMOLINA