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General NPI Number Information
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NPI Number | 1750022406
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Entity Type | Organization
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Legal Business Name | GAADRA ENTERPRISE PLLC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 575 S 70TH ST STE 310
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City | LINCOLN
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State | NE
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Zip | 68510-2471
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Country | US
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Telephone | 336-749-9354
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 GROVE CREEK DR
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City | LEWISVILLE
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State | NC
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Zip | 27023-3004
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Country | US
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Telephone | 336-749-9354
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAMAL A ELSAIDI
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Credential |
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Telephone | 336-749-9354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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