Provider Demographics
NPI:1851934434
Name:MIDLAND VISITING DOCTORS MANAGEMENT LLC
Entity Type:Organization
Organization Name:MIDLAND VISITING DOCTORS MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-415-9856
Mailing Address - Street 1:17330 PRESTON RD STE 170A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5796
Mailing Address - Country:US
Mailing Address - Phone:469-242-3826
Mailing Address - Fax:469-242-3827
Practice Address - Street 1:17330 PRESTON RD STE 170A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5796
Practice Address - Country:US
Practice Address - Phone:972-415-9856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty