Provider Demographics
NPI:1457107765
Name:OPTIMAL WEIGHT LOSS AND SURGERY CONSULTANTS LLC
Entity type:Organization
Organization Name:OPTIMAL WEIGHT LOSS AND SURGERY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-650-7144
Mailing Address - Street 1:12606 GREENVILLE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1927
Mailing Address - Country:US
Mailing Address - Phone:214-971-8802
Mailing Address - Fax:949-703-7227
Practice Address - Street 1:12606 GREENVILLE AVE STE 205
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1927
Practice Address - Country:US
Practice Address - Phone:214-971-8802
Practice Address - Fax:949-703-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty