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General NPI Number Information
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NPI Number | 1053228130
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Entity Type | Organization
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Legal Business Name | LIFESTYLE BARIATRICS AND VASCULAR HEALTH
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 9525 N BEACH ST STE 405
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City | FORT WORTH
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State | TX
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Zip | 76244-6438
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Country | US
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Telephone | 972-342-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 812 CHARLESTON DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1534
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Country | US
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Telephone | 972-342-5105
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ARSALLA ISLAM
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Credential | M.D.
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Telephone | 972-342-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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