Healthcare Provider Details

I. General information

NPI: 1609532365
Provider Name (Legal Business Name): ELITE CARDIOVASCULAR GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 YORK DR
DESOTO TX
75115-2043
US

IV. Provider business mailing address

2101 SHANNON OXMOOR RD # 270
SHANNON AL
35142-2000
US

V. Phone/Fax

Practice location:
  • Phone: 972-572-1600
  • Fax:
Mailing address:
  • Phone: 205-880-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NIKHIL NALLURI
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 205-880-7575