Provider Demographics
NPI:1194912832
Name:HORIZON VEIN LASER&AESTHETICS CLINIC PA
Entity type:Organization
Organization Name:HORIZON VEIN LASER&AESTHETICS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-980-4400
Mailing Address - Street 1:PO BOX 803311
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-3311
Mailing Address - Country:US
Mailing Address - Phone:972-661-8884
Mailing Address - Fax:972-980-4100
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:SUITE #300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-661-8884
Practice Address - Fax:972-980-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG7721OtherMEDICAL LICENSE
TX00058NMedicare PIN
TXG7721OtherMEDICAL LICENSE