Organization
SANDRA ILLUM MD PLLC
Active
Other names
Advanced Heart and Vascular Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNIKA SANDRA ILLUM MD (CARDIOLOGIST)
(214) 377-7576
Entity
Organization
Contact information
Practice address
17101 PRESTON RD STE 190S, DALLAS, TX 75248-1331
(214) 500-1689
Mailing address
17101 PRESTON RD, DALLAS, TX 75248-1331
(214) 377-7576
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
P1086
TX
261QM2500X
Medical Specialty Clinic/Center
P1086
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U3Z7
BCBS
TX
Enumeration date
03/20/2017
Last updated
07/21/2022
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