MEDICARE: OMNITELAMED PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1154903326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNITELAMED PLLC

Provider Business Mailing Address
First Line	:	23 LAUREL WREATH TRL
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-2393
Country	:	US
Telephone Number	:	407-739-1415
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 LAUREL WREATH TRL
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-2393
Country	:	US
Telephone Number	:	407-739-1415
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HASAN ALI KAKLI
Credential	:	MD
Telephone Number	:	407-739-1415

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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