Provider Demographics
NPI:1881070977
Name:EXECUTIVE HEALTH AND WELLNESS OF TEXAS
Entity type:Organization
Organization Name:EXECUTIVE HEALTH AND WELLNESS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:P
Authorized Official - Last Name:KUSHWAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-852-9140
Mailing Address - Street 1:1643 LANCASTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3593
Mailing Address - Country:US
Mailing Address - Phone:817-328-0349
Mailing Address - Fax:972-852-9094
Practice Address - Street 1:1643 LANCASTER DR STE 201
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3593
Practice Address - Country:US
Practice Address - Phone:817-328-0349
Practice Address - Fax:972-852-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty