Provider Demographics
NPI:1619433034
Name:MARIPOSA PERINATAL SERVICES PLLC
Entity type:Organization
Organization Name:MARIPOSA PERINATAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MLADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PREDANIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-506-2617
Mailing Address - Street 1:9330 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4310
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:214-506-1170
Practice Address - Street 1:1510 W. HWY 287 BYPASS
Practice Address - Street 2:STE. 100
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-905-3778
Practice Address - Fax:844-213-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty