Provider Demographics
NPI:1538503735
Name:MADNI, DINA (MD)
Entity type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:MADNI
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:ITUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7777 FOREST LN STE A331
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2538
Mailing Address - Country:US
Mailing Address - Phone:972-566-4635
Mailing Address - Fax:972-566-6673
Practice Address - Street 1:7777 FOREST LN STE A331
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2538
Practice Address - Country:US
Practice Address - Phone:972-566-7860
Practice Address - Fax:972-566-6673
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407513701Medicaid
TX407514501Medicaid