Provider Demographics
NPI:1982886693
Name:KIDDIE DOCS
Entity Type:Organization
Organization Name:KIDDIE DOCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:ANIL
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-359-1400
Mailing Address - Street 1:1505 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4692
Mailing Address - Country:US
Mailing Address - Phone:972-359-1400
Mailing Address - Fax:972-359-8676
Practice Address - Street 1:1505 W MCDERMOTT DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4692
Practice Address - Country:US
Practice Address - Phone:972-359-1400
Practice Address - Fax:972-359-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011MDOtherBCBS
TX=========OtherTAX ID
TX0011MDOtherBCBS