Provider Demographics
NPI:1891845582
Name:CHARLES F. NATALIZIO MD
Entity Type:Organization
Organization Name:CHARLES F. NATALIZIO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:NATALIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-1800
Mailing Address - Street 1:4001 W 15TH ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5841
Mailing Address - Country:US
Mailing Address - Phone:972-867-1800
Mailing Address - Fax:972-867-1810
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:SUITE 480
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:972-867-1800
Practice Address - Fax:972-867-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX52615339Medicaid
TX52615339Medicaid
TX52615339Medicaid
TX0098BCMedicare ID - Type Unspecified
TX52615339Medicaid