Basic Information
| Provider Information | |||||||||
| NPI: | 1952864365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STAR NEURO PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3140 LEGACY DR STE 300 | ||||||||
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| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750349566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729541469 | ||||||||
| FaxNumber: | 4692832743 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 S BELT LINE RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750194884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724354070 | ||||||||
| FaxNumber: | 4692832743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | YOUNAS | ||||||||
| AuthorizedOfficialFirstName: | BABER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9729541469 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.