Provider Demographics
NPI:1750478913
Name:NEUROLOGY DIAGNOSTIC CENTERS OF DALLAS INC
Entity type:Organization
Organization Name:NEUROLOGY DIAGNOSTIC CENTERS OF DALLAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-363-3623
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:STE 585
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0811
Mailing Address - Country:US
Mailing Address - Phone:214-363-3623
Mailing Address - Fax:214-363-0869
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:STE 585
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0811
Practice Address - Country:US
Practice Address - Phone:214-363-3623
Practice Address - Fax:214-363-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184306201Medicaid
TX00X155Medicare PIN