Sandra Illum MD PLLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

P1086 Issued in TX

Legal business name

SANDRA ILLUM MD PLLC

Doing business as

Advanced Heart and Vascular Center

Practice address

17101 Preston Rd Ste 190S
Dallas, TX 75248-1331

Phone

(214) 500-1689

NPI assigned

Mar 20, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Annika Sandra Illum, MDNPI 1588865778

Title

Cardiologist

Phone

(214) 377-7576

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Advanced Heart and Vascular Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Annika S Illum, M.D.

  • Cardiovascular Disease Physician
  • Dallas, TX
  • NPI 1588865778
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1144761404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17101 PRESTON RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481331",
            "telephone_number": "214-377-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17101 PRESTON RD STE 190S",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481331",
            "telephone_number": "214-500-1689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA ILLUM MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ILLUM",
        "authorized_official_first_name": "ANNIKA",
        "authorized_official_middle_name": "SANDRA",
        "authorized_official_title_or_position": "CARDIOLOGIST",
        "authorized_official_telephone_number": "214-377-7576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "TX",
            "license": "P1086",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "P1086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00U3Z7",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Heart and Vascular Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Heart and Vascular Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gisela Guadalupe Sandoval, COTA
• Jennifer Sandoval
• Jessica Sandoval, BCBA
• Sal S Sandoval, MD
• Sandra E Cuellar DPM , P.C. (Park Cities Foot Center)
• Sandra Z. Brothers, MD, PA
• Alexander Sands, MD
• Rachel Anne Sands, PA
• Christina Marie Sandwell, DO
• Sandy Harris (Community Care Solutions)

• Cardiovascular Disease Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Cardiovascular Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.