Provider Demographics
NPI:1801870308
Name:LWIN, THIDA (MD)
Entity type:Individual
Prefix:
First Name:THIDA
Middle Name:
Last Name:LWIN
Suffix:
Gender:F
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:PO BOX 164045
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-4045
Mailing Address - Country:US
Mailing Address - Phone:214-596-2255
Mailing Address - Fax:214-596-2297
Practice Address - Street 1:8400 ESTERS BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2203
Practice Address - Country:US
Practice Address - Phone:214-596-2255
Practice Address - Fax:214-596-2297
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034304207ZP0102X
MN47156207ZP0102X
TXM1898207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI07183Medicare UPIN