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General NPI Number Information
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NPI Number | 1801588017
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Entity Type | Organization
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Legal Business Name | ELIXIR MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 15340 DALLAS PKWY STE 2740
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City | DALLAS
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State | TX
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Zip | 75248-4664
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Country | US
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Telephone | 217-819-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 6802 CHESWICK CT
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City | PARKER
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State | TX
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Zip | 75002-3024
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Country | US
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Telephone | 217-819-2417
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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 | MOSTAFA S ELSAKKA
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Credential | MD
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Telephone | 217-819-2417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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