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General NPI Number Information
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NPI Number | 1902630395
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Entity Type | Organization
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Legal Business Name | ELITE CARE INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 4017 E PLANO PKWY STE 400
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City | PLANO
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State | TX
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Zip | 75074-1841
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Country | US
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Telephone | 918-501-9913
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Fax |
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Provider Business Mailing Address
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Address Line | 4017 E PLANO PKWY STE 400
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City | PLANO
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State | TX
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Zip | 75074-1841
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Country | US
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Telephone | 918-501-9913
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MHD YASSER DARKAZALLY
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Credential | MD
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Telephone | 918-501-9913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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