Healthcare Provider Details

I. General information

NPI: 1770496002
Provider Name (Legal Business Name): MEDORA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N GREENVILLE AVE STE 606
ALLEN TX
75002-2167
US

IV. Provider business mailing address

705 N GREENVILLE AVE STE 606
ALLEN TX
75002-2167
US

V. Phone/Fax

Practice location:
  • Phone: 312-446-0536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAROOQ ALI BAIG MIRZA
Title or Position: CEO
Credential:
Phone: 312-446-0536