Provider Demographics
NPI:1770217960
Name:MULTI SPECIALTY GROUP OF NORTH TEXAS PLLC
Entity Type:Organization
Organization Name:MULTI SPECIALTY GROUP OF NORTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-505-2932
Mailing Address - Street 1:4927 LAKE RIDGE PKWY STE 148
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3087
Mailing Address - Country:US
Mailing Address - Phone:313-505-2932
Mailing Address - Fax:
Practice Address - Street 1:4927 LAKE RIDGE PKWY STE 148
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3087
Practice Address - Country:US
Practice Address - Phone:313-505-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty