1083176044 NPI number — KATIE DANIELLE DOLAK MD (MAY 2019)

Table of content: KATIE DANIELLE DOLAK MD (MAY 2019) (NPI 1083176044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083176044 NPI number — KATIE DANIELLE DOLAK MD (MAY 2019)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLAK
Provider First Name:
KATIE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD (MAY 2019)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOLAK
Provider Other First Name:
KATIE
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083176044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1935 MEDICAL DISTRICT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-7701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1935 MEDICAL DISTRICT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-456-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)