Provider Demographics
NPI:1316929375
Name:PODOLSKY, DANIEL KALMAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KALMAN
Last Name:PODOLSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BOULEVARD
Mailing Address - Street 2:(B12.100)
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9002
Mailing Address - Country:US
Mailing Address - Phone:214-648-2508
Mailing Address - Fax:214-648-8690
Practice Address - Street 1:1801 INWOOD ROAD,
Practice Address - Street 2:6TH FLOOR, SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-645-0595
Practice Address - Fax:214-645-0581
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45936207RG0100X
TX42347207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX#8BQ932OtherBLUE CROSS/BLUE SHIELD OF TEXAS
MA0152579Medicaid
MA045936OtherTUFTS HEALTH PLAN
MAE05681OtherBCBS MA
TX#8BQ932OtherBLUE CROSS/BLUE SHIELD OF TEXAS
MAE05681OtherBCBS MA
TX8L6638Medicare PIN