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General NPI Number Information
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NPI Number | 1457107765
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Entity Type | Organization
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Legal Business Name | OPTIMAL WEIGHT LOSS AND SURGERY CONSULTANTS LLC
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 12606 GREENVILLE AVE STE 205
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City | DALLAS
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State | TX
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Zip | 75243-1927
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Country | US
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Telephone | 214-971-8802
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Fax | 949-703-7227
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Provider Business Mailing Address
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Address Line | 12606 GREENVILLE AVE STE 205
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City | DALLAS
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State | TX
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Zip | 75243-1927
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Country | US
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Telephone | 214-971-8802
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Fax | 949-703-7227
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. TARIK AL-KALLA
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Credential | MD
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Telephone | 281-650-7144
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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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