Provider Demographics
NPI:1609532365
Name:ELITE CARDIOVASCULAR GROUP PLLC
Entity Type:Organization
Organization Name:ELITE CARDIOVASCULAR GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-880-7575
Mailing Address - Street 1:2101 SHANNON OXMOOR RD # 270
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-2000
Mailing Address - Country:US
Mailing Address - Phone:205-880-7575
Mailing Address - Fax:
Practice Address - Street 1:925 YORK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2043
Practice Address - Country:US
Practice Address - Phone:972-572-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty