Individual
DR. ANNIKA S ILLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17101 PRESTON RD STE 190-S, DALLAS, TX 75248-1331
(214) 377-7576
(214) 377-7690
Mailing address
17101 PRESTON RD STE 190-S, DALLAS, TX 75248-1331
(214) 377-7576
(214) 377-7690
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD.200464
LA
207RC0000X
Cardiovascular Disease Physician
Primary
P1086
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U3Z7
BCBS
TX
Enumeration date
05/29/2007
Last updated
07/21/2022
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