Provider Demographics
NPI:1669412490
Name:MULTICARE MEDICAL GROUP
Entity type:Organization
Organization Name:MULTICARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-238-1976
Mailing Address - Street 1:208 W SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4034
Mailing Address - Country:US
Mailing Address - Phone:972-238-1976
Mailing Address - Fax:972-238-0456
Practice Address - Street 1:208 W SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4034
Practice Address - Country:US
Practice Address - Phone:972-238-1976
Practice Address - Fax:972-238-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2028208D00000X
TXDC2665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN
TX00565RMedicare ID - Type UnspecifiedGROUP NUMBER