# NORTH TEXAS ID PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215386933
- **Authorized official:** DR. DHIRAJ KOTWAL MD (PRESIDENT)
- **Authorized official phone:** (972) 853-7170

## Contact information

- **Practice address:** 4517 SOUTHGATE DR, PLANO, TX 75024-2138
- **Practice address phone:** (972) 853-7170
- **Mailing address:** 4517 SOUTHGATE DR, PLANO, TX 75024-2138
- **Mailing address phone:** (972) 853-7170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | M 8773 | TX | Yes |

## Other

- **Enumeration date:** 06/03/2016
- **Last updated:** 06/03/2016