Provider Demographics
NPI:1255426714
Name:IHDE SURGICAL GROUP, PA
Entity type:Organization
Organization Name:IHDE SURGICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:IHDE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:817-467-3000
Mailing Address - Street 1:515 W. MAYFIELD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014
Mailing Address - Country:US
Mailing Address - Phone:817-467-3000
Mailing Address - Fax:817-467-3001
Practice Address - Street 1:515 W. MAYFIELD
Practice Address - Street 2:SUITE 402
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-467-3000
Practice Address - Fax:817-467-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty