Provider Demographics
NPI:1588022800
Name:HEAL 360 PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:HEAL 360 PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-900-6009
Mailing Address - Street 1:1313 BRAVURA DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0107
Mailing Address - Country:US
Mailing Address - Phone:972-226-8900
Mailing Address - Fax:469-861-8625
Practice Address - Street 1:2806 W FM 544
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7022
Practice Address - Country:US
Practice Address - Phone:972-226-8900
Practice Address - Fax:972-218-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty