Provider Demographics
NPI:1043781602
Name:MEDTOPIA MEDICAL, PLLC
Entity type:Organization
Organization Name:MEDTOPIA MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-419-0049
Mailing Address - Street 1:8230 WALNUT HILL LN STE 414
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4469
Mailing Address - Country:US
Mailing Address - Phone:214-497-7148
Mailing Address - Fax:
Practice Address - Street 1:8230 WALNUT HILL LN STE 414
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4469
Practice Address - Country:US
Practice Address - Phone:214-497-7148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty