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General NPI Number Information
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NPI Number | 1891390282
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Entity Type | Organization
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Legal Business Name | SHED BY DR. K, PA
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 6020 W PARKER RD STE 430
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City | PLANO
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State | TX
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Zip | 75093-0001
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Country | US
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Telephone | 214-734-5792
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Fax |
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Provider Business Mailing Address
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Address Line | 4632 RIDGE LN
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City | CARROLLTON
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State | TX
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Zip | 75010-1210
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Country | US
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Telephone | 214-734-5792
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW KHALIL
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Credential | DO
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Telephone | 214-734-5792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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