Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K4338 | TX |
N | 2080P0208X | Pediatric Infectious Diseases | K4338 | TX |
NPI | 1568486389 |
---|---|
Provider Name | Dr. Michael Adam Tolle |
First Address | Dallas, TX 75231-3816 |
Second Address | Dallas, TX 75231-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092308801 | (05) | TX |
G78808 | (02) | TX |