Provider Demographics
NPI:1912224684
Name:MISI, PA
Entity Type:Organization
Organization Name:MISI, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-884-4400
Mailing Address - Street 1:10400 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2297
Mailing Address - Country:US
Mailing Address - Phone:972-884-4400
Mailing Address - Fax:972-884-4411
Practice Address - Street 1:10400 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2297
Practice Address - Country:US
Practice Address - Phone:972-884-4400
Practice Address - Fax:972-884-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty