Basic Information
| Provider Information | |||||||||
| NPI: | 1477870202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIFAMILIA MEDICAL PLLC | ||||||||
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| OtherOrganizationName: | GRAND PRAIRIE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9090 SKILLMAN | ||||||||
| Address2: | STE 200C | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752438259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143425757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 928 N BELT LINE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723141311 | ||||||||
| FaxNumber: | 9723141315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2010 | ||||||||
| LastUpdateDate: | 05/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | MALOUF | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2143425757 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | K0518 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.