Healthcare Provider Details

I. General information

NPI: 1093478489
Provider Name (Legal Business Name): SHIBLI FAMILY MEDICINE AND OBESITY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 US HIGHWAY 80 E
MESQUITE TX
75149-1555
US

IV. Provider business mailing address

5045 MULHOLLAND DR
PLANO TX
75074-7036
US

V. Phone/Fax

Practice location:
  • Phone: 469-827-7300
  • Fax: 469-202-0120
Mailing address:
  • Phone: 412-378-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: UROOJ SHIBLI
Title or Position: OWNER
Credential: MD
Phone: 412-378-0755