Provider Demographics
NPI:1821225772
Name:DENTON PROFESSIONAL MEDICAL GROUP,PLLC
Entity Type:Organization
Organization Name:DENTON PROFESSIONAL MEDICAL GROUP,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-381-0885
Mailing Address - Street 1:3201 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6863
Mailing Address - Country:US
Mailing Address - Phone:940-381-0885
Mailing Address - Fax:940-380-0382
Practice Address - Street 1:3201 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6863
Practice Address - Country:US
Practice Address - Phone:940-381-0885
Practice Address - Fax:940-380-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5264208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty