Provider Demographics
NPI:1962475814
Name:PILATOVSKY, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PILATOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11910 GREENVILLE AVE
Mailing Address - Street 2:#500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3596
Mailing Address - Country:US
Mailing Address - Phone:214-572-1124
Mailing Address - Fax:214-572-7724
Practice Address - Street 1:5076 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4471
Practice Address - Country:US
Practice Address - Phone:972-733-0095
Practice Address - Fax:972-733-4072
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8618M1Medicare ID - Type Unspecified
TXB25510Medicare UPIN