Organization
FORMA MEDICAL GROUP LLC
Active
Other names
Dallas Diagnostic Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANUP TILAK (OWNER)
(319) 594-4108
Entity
Organization
Contact information
Practice address
570 EDMONDS LANE, SUITE - 104 / 106B, LEWISVILLE, TX 75067-3542
(319) 594-4108
Mailing address
570 EDMONDS LANE, SUITE - 104 / 106B, LEWISVILLE, TX 75067-3542
(319) 594-4108
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
01/12/2023
Last updated
03/06/2025
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