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General NPI Number Information
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NPI Number | 1730972910
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Entity Type | Organization
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Legal Business Name | PRESTIGE MD CONCIERGE PLLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 75 MIRANDA LAMBERT WAY STE 19
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City | LINDALE
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State | TX
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Zip | 75771-3107
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Country | US
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Telephone | 786-708-5509
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Fax | 903-202-1314
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Provider Business Mailing Address
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Address Line | 2812 OAK CREEK BLVD
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City | TYLER
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State | TX
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Zip | 75703-1260
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Country | US
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Telephone | 903-253-2717
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Fax |
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. MOHAMMAD SAMIULLAH
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Credential | MD
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Telephone | 903-253-2717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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