Provider Demographics
NPI:1134435381
Name:MARK CWIKLA MD PA
Entity type:Organization
Organization Name:MARK CWIKLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-4768
Mailing Address - Street 1:7301 STATE HIGHWAY 161
Mailing Address - Street 2:STE 161
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2816
Mailing Address - Country:US
Mailing Address - Phone:972-259-4768
Mailing Address - Fax:
Practice Address - Street 1:405 STATE HIGHWAY 121 BYP
Practice Address - Street 2:BUILDING A STE 150
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8214
Practice Address - Country:US
Practice Address - Phone:972-869-4768
Practice Address - Fax:972-254-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3678207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty