| Organization Name: | ADDISON INTERNAL MEDICINE |
| NPI Number: | 1043695695 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRI NGUYEN (MEDICAL DIRECTOR) |
| Mailing Address: | 17051 Dallas Pkwy Ste 150 Addison |
| State: | TX US |
| Postal Code: | 750017106 |
| Phone Number: | 9727333090 |
| Fax Number: | 9727334565 |
| NPI Enumeration Date: | 07/24/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP128604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |