Basic Information
| Provider Information | |||||||||
| NPI: | 1073608667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLODKY | ||||||||
| FirstName: | INNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26726 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787550726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124078686 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 MILLS AVE | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787316309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123244083 | ||||||||
| FaxNumber: | 5123244717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 11/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M0281 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | M0281 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 210700507 | 05 | TX | MEDICAID | 0028MH | 01 | TN | BLUE CROSS | OTHER | 210700508 | 05 | TX | MEDICAID |