Provider Demographics
NPI:1255197653
Name:THE DALLAS CLINIC 23 PLLC
Entity type:Organization
Organization Name:THE DALLAS CLINIC 23 PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEHETAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDURRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-634-8110
Mailing Address - Street 1:2701 PRINCE GEORGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2087
Mailing Address - Country:US
Mailing Address - Phone:972-555-5555
Mailing Address - Fax:
Practice Address - Street 1:2701 PRINCE GEORGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2087
Practice Address - Country:US
Practice Address - Phone:972-634-8110
Practice Address - Fax:972-634-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty