Provider Demographics
NPI:1730972910
Name:PRESTIGE MD CONCIERGE PLLC
Entity type:Organization
Organization Name:PRESTIGE MD CONCIERGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-253-2717
Mailing Address - Street 1:2812 OAK CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1260
Mailing Address - Country:US
Mailing Address - Phone:903-253-2717
Mailing Address - Fax:
Practice Address - Street 1:75 MIRANDA LAMBERT WAY STE 19
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-3107
Practice Address - Country:US
Practice Address - Phone:786-708-5509
Practice Address - Fax:903-202-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty