| Havenfuse IV Center | |
|
6600 Lyndon B Johnson Fwy Ste 190 Dallas TX 75240-6519 | |
| (214) 725-5039 | |
| Not Available |
| Full Name | Havenfuse IV Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 6600 Lyndon B Johnson Fwy Ste 190, Dallas, Texas |
| Authorized Official Name and Position | Aviva M Rosenberg (OWNER) |
| Authorized Official Contact | 2146958729 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Havenfuse IV Center 6600 Lyndon B Johnson Fwy Ste 190 Dallas TX 75240-6519 Ph: (214) 725-5039 | Havenfuse IV Center 6600 Lyndon B Johnson Fwy Ste 190 Dallas TX 75240-6519 Ph: (214) 725-5039 |
| NPI Number | 1295534360 |
|---|---|
| Provider Enumeration Date | 03/11/2025 |
| Last Update Date | 03/11/2025 |
| Certification Date | 03/11/2025 |
| Medicare PECOS PAC ID | 9931622263 |
|---|---|
| Medicare Enrollment ID | O20250327002361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295534360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 363L00000X | Nurse Practitioner | () | Secondary |
| Provider Name | Dan Lender |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1760445274 PECOS PAC ID: 2466624358 Enrollment ID: I20111019000592 |
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