Healthcare Provider Details

I. General information

NPI: 1063355071
Provider Name (Legal Business Name): PROSPER PRIMARY CARE AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 W UNIVERSITY DR STE 50
PROSPER TX
75078-9993
US

IV. Provider business mailing address

3740 W UNIVERSITY DR STE 50
PROSPER TX
75078-9993
US

V. Phone/Fax

Practice location:
  • Phone: 469-592-6599
  • 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: SUHAIB TAIE
Title or Position: SENIOR ADMINISTRATOR
Credential:
Phone: 469-592-6599