=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780863480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLAHI HEART CLINIC, P.A., TEXAS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 12/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 W ARBROOK BLVD STE 220
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76014-3176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-419-7220
-----------------------------------------------------
Fax | 817-419-7222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 W ARBROOK BLVD STE 220
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76014-3176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-419-7220
-----------------------------------------------------
Fax | 817-419-7222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ATIF SOHAIL
-----------------------------------------------------
Credential | M.D., F.A.C.C.
-----------------------------------------------------
Telephone | 817-419-7220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 7782178
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------