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Organization
MYCLINIC LLC
Active
Organization
MYCLINIC LLC
Active
Other names
My Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FEDERICO MAESE MD (PRESIDENT)
(214) 537-7615
Entity
Organization
Contact information
Practice address
2440 S COLLINS ST, ARLINGTON, TX 76014-1239
(214) 537-7615
Mailing address
2440 S COLLINS ST, ARLINGTON, TX 76014-1239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J4319
TX
207R00000X
Internal Medicine Physician
J4319
TX
207RC0000X
Cardiovascular Disease Physician
J4319
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067CD
MEDICARE
TX
05
—
131230801
—
TX
01
—
J4319
TEXAS STATE BOARD OF MEDICAL EXAMINERS
TX
Enumeration date
02/28/2011
Last updated
08/12/2019
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