Basic Information
| Provider Information | |||||||||
| NPI: | 1730450115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS PHLEBOLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2015 SPRING RD STE 300 | ||||||||
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| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605233944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6149 WINDHAVEN PKWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252730 | ||||||||
| FaxNumber: | 6307252783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2012 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6307252737 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.