| Ap US 14, PA | |
|
1717 Main St Ste 5850 Dallas TX 75201-7317 | |
| (972) 449-0540 | |
| (972) 449-0550 |
| Full Name | Ap US 14, PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 1717 Main St Ste 5850, Dallas, Texas |
| Authorized Official Name and Position | Christopher Gallagher (CEO/PRESIDENT) |
| Authorized Official Contact | 9724490540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ap US 14, PA 1717 Main St Ste 5850 Dallas TX 75201-7317 Ph: (972) 449-0540 | Ap US 14, PA 1717 Main St Ste 5850 Dallas TX 75201-7317 Ph: (972) 449-0540 |
| NPI Number | 1902415904 |
|---|---|
| Provider Enumeration Date | 07/24/2020 |
| Last Update Date | 10/14/2024 |
| Certification Date | 10/14/2024 |
| Medicare PECOS PAC ID | 5698185908 |
|---|---|
| Medicare Enrollment ID | O20201027003032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902415904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (NU) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | (NU) | Secondary |
| Provider Name | Paulgun Sulur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811037286 PECOS PAC ID: 1557444643 Enrollment ID: I20191028002634 |
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