MEDICARE: PROSPER PRIMARY CARE AND WELLNESS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1063355071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPER PRIMARY CARE AND WELLNESS PC

Provider Business Mailing Address
First Line	:	3740 W UNIVERSITY DR STE 50
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-9993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 W UNIVERSITY DR STE 50
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-9993
Country	:	US
Telephone Number	:	469-592-6599
Fax Number	:

Authorized Official
Title or Position	:	SENIOR ADMINISTRATOR
Name	:	SUHAIB TAIE
Credential	:
Telephone Number	:	469-592-6599

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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