| Idmdtx | |
|
1307 8th Ave Ste 306 Fort Worth TX 76104-4140 | |
| (813) 943-2570 | |
| Not Available |
| Full Name | Idmdtx |
|---|---|
| Speciality | Internal Medicine |
| Location | 1307 8th Ave Ste 306, Fort Worth, Texas |
| Authorized Official Name and Position | Miloni Shroff (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8139432570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idmdtx 4843 Colleyville Blvd # 251-103 Colleyville TX 76034-3923 | Idmdtx 1307 8th Ave Ste 306 Fort Worth TX 76104-4140 Ph: (813) 943-2570 |
| NPI Number | 1649093832 |
|---|---|
| Provider Enumeration Date | 11/05/2024 |
| Last Update Date | 02/21/2025 |
| Certification Date | 02/21/2025 |
| Medicare PECOS PAC ID | 3375060460 |
|---|---|
| Medicare Enrollment ID | O20250513000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649093832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | () | Primary |
| Provider Name | Miloni Shroff |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1447488028 PECOS PAC ID: 5294956413 Enrollment ID: I20170928000273 |
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