Basic Information
| Provider Information | |||||||||
| NPI: | 1104060904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDKOVSKY | ||||||||
| FirstName: | URIEL | ||||||||
| MiddleName: | SEBASTIAN | ||||||||
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| Credential: | MD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3409 WORTH ST STE 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148232533 | ||||||||
| FaxNumber: | 2148233270 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 WORTH ST STE 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148232533 | ||||||||
| FaxNumber: | 2148233270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2009 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R5933 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 25101 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | R5933 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 217010202 | 05 | TX | MEDICAID |