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Sandra Illum Md Pllc
Medical Specialty Clinic/Center in Dallas, Texas
NPI 1144761404

Sandra Illum Md Pllc is a Medical Specialty Clinic/Center based in Dallas, TX and is specialized in Medical Specialty. Sandra Illum Md Pllc practices in Dallas, TX. The NPI Number for Sandra Illum Md Pllc is 1144761404 and holds a License No. P1086 (Texas).

The current practice location address for Sandra Illum Md Pllc is 17101 Preston Rd Ste 190S, Dallas, TX and can be reached out via phone at 214-500-1689.

Location: 17101 Preston Rd Ste 190S, Dallas, TX, 75248-1331
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1144761404
Provider Name
Sandra Illum Md Pllc
Credential
Provider Entity Type
Organization
Address
17101 Preston Rd Ste 190S, Dallas, TX, 75248-1331
Phone Number
214-500-1689
Fax Number
Provider Enumeration Date
03/20/2017
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00U3Z7 01 TX BCBS
institution
Provider Business Practice Location Address Details
Address
17101 Preston Rd Ste 190S
City
Dallas
State
Texas
Zip
75248-1331
Phone Number
214-500-1689
Fax Number
person
Provider Business Mailing Address Details
Address
17101 Preston Rd Ste 190S
City
Dallas
State
Texas
Zip
75248-1331
Phone Number
214-500-1689
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Cardiovascular Disease
Taxonomy
207RC0000X
License No.
P1086 (Texas)
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
P1086 (Texas)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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