Organization
NEUROLOGICAL DOCTORS OF DALLAS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEAL I VENGROW (PRESIDENT)
(214) 575-6633
Entity
Organization
Contact information
Practice address
11884 GREENVILLE AVE STE 110A, DALLAS, TX 75243-3537
(214) 575-6633
(214) 575-6638
Mailing address
11884 GREENVILLE AVE STE 110A, DALLAS, TX 75243-3537
(214) 575-6633
(214) 575-6638
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
K0230
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00400K
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/11/2007
Last updated
12/11/2007
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