Provider Demographics
NPI:1912385493
Name:SHMG MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:SHMG MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-597-0195
Mailing Address - Street 1:330 LAS COLINAS BLVD E
Mailing Address - Street 2:1620
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6175 MAIN ST
Practice Address - Street 2:350
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3441
Practice Address - Country:US
Practice Address - Phone:972-767-5923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty