=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306727318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCEPT HEALTH CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 399 W CAMPBELL RD STE 304
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-235-2304
-----------------------------------------------------
Fax | 972-235-8442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 399 W CAMPBELL ROAD SUITE 304
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-235-2304
-----------------------------------------------------
Fax | 972-235-8442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAFAY LATIF
-----------------------------------------------------
Credential | MD/MHA
-----------------------------------------------------
Telephone | 972-235-2304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------