Provider Demographics
NPI:1902380009
Name:PELICAN MEDICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:PELICAN MEDICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOIZUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-647-9910
Mailing Address - Street 1:1022 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5828
Mailing Address - Country:US
Mailing Address - Phone:972-674-9910
Mailing Address - Fax:
Practice Address - Street 1:5012 US HWY 75 STE 205
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4635
Practice Address - Country:US
Practice Address - Phone:972-674-9910
Practice Address - Fax:972-666-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405864601Medicaid