Provider Demographics
NPI:1932279577
Name:PENDOLA, MICHAEL J (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHAEL
Middle Name:J
Last Name:PENDOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3409 WORTH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:214-824-1730
Mailing Address - Fax:214-283-4337
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-824-1730
Practice Address - Fax:214-283-4337
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
TXL4638208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1668931-01Medicaid
TX394637YKY6Medicare PIN
TX1668931-01Medicaid