Healthcare Provider Details

I. General information

NPI: 1285249706
Provider Name (Legal Business Name): KSALEH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 11/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MEDICAL CENTER DR STE 200
MCKINNEY TX
75069-1769
US

IV. Provider business mailing address

720 FRISCO HILLS BLVD
LITTLE ELM TX
75068-5297
US

V. Phone/Fax

Practice location:
  • Phone: 214-934-9267
  • Fax: 469-930-0197
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SADIA AZIZ
Title or Position: OFFICE MANAGER
Credential: OFFICE MANGER
Phone: 214-934-9267