Provider Demographics
NPI:1134985591
Name:LOVEDALE ENTERPRISES
Entity type:Organization
Organization Name:LOVEDALE ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:SHAKOOR
Authorized Official - Last Name:BOODHWANI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:214-430-4384
Mailing Address - Street 1:2100 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-1900
Mailing Address - Country:US
Mailing Address - Phone:214-943-4631
Mailing Address - Fax:877-416-0310
Practice Address - Street 1:2100 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1900
Practice Address - Country:US
Practice Address - Phone:214-430-4384
Practice Address - Fax:214-430-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty