Provider Demographics
NPI:1215761283
Name:NORTH TEXAS CONCIERGE MEDICINE, PLLC
Entity type:Organization
Organization Name:NORTH TEXAS CONCIERGE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FOAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIAMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-425-2659
Mailing Address - Street 1:1400 N COIT RD STE 1401
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6660
Mailing Address - Country:US
Mailing Address - Phone:469-425-2659
Mailing Address - Fax:469-640-9042
Practice Address - Street 1:1400 N COIT RD STE 1401
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6660
Practice Address - Country:US
Practice Address - Phone:972-333-0802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty