Organization
CWIDA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN FOJTAEK MD (OWNER)
(972) 661-2273
Entity
Organization
Contact information
Practice address
15800 DOOLEY RD STE 170, ADDISON, TX 75001-5712
(972) 661-2273
(866) 292-6489
Mailing address
4400 W UNIVERSITY BLVD, APT: 10306, DALLAS, TX 75209-3876
(817) 729-5793
(866) 292-6489
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
767459
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
AP125351
TX
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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