| Elite Interns Pllc | |
|
8067 W Virginia Dr Ste 200 Dallas TX 75237-3767 | |
| (972) 230-5601 | |
| Not Available |
| Full Name | Elite Interns Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8067 W Virginia Dr Ste 200, Dallas, Texas |
| Authorized Official Name and Position | Pankaj Nakarani (COO) |
| Authorized Official Contact | 9094799260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Interns Pllc 8067 W Virginia Dr Dallas TX 75237-3767 Ph: (972) 230-5601 | Elite Interns Pllc 8067 W Virginia Dr Ste 200 Dallas TX 75237-3767 Ph: (972) 230-5601 |
| NPI Number | 1073968517 |
|---|---|
| Provider Enumeration Date | 05/03/2016 |
| Last Update Date | 04/19/2024 |
| Medicare PECOS PAC ID | 4880968353 |
|---|---|
| Medicare Enrollment ID | O20170921002329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073968517 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | P0505 (Texas) | Primary |
| 261QP2300X | Clinic/center - Primary Care | N8334 (Texas) | Secondary |
| Provider Name | Ketan P Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003814146 PECOS PAC ID: 6305730508 Enrollment ID: I20040210000170 |
| Provider Name | Oladele O Olusanya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073542429 PECOS PAC ID: 6800887886 Enrollment ID: I20040519000700 |
| Provider Name | Laquita A Shepherd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063483998 PECOS PAC ID: 2062691819 Enrollment ID: I20110125000988 |
| Provider Name | Manjit Kaur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639724628 PECOS PAC ID: 2567895436 Enrollment ID: I20191206000760 |
| Provider Name | Shantau Asua Valentine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114770229 PECOS PAC ID: 9739625583 Enrollment ID: I20240729002103 |
| Provider Name | Kristen Caroline Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316529704 PECOS PAC ID: 4486191996 Enrollment ID: I20240801003202 |
| Provider Name | Azra Yasmeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275365280 PECOS PAC ID: 2668912239 Enrollment ID: I20240910002003 |
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