=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841942646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLA MEDICAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2022
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4010 W PARK BLVD
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-482-4291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4010 W PARK BLVD
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-482-4291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PHYSICIAN
-----------------------------------------------------
Name | MAHDI AWWAD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-754-4284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------