MEDICARE: NORTHSTAR MOHS AND SKIN SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician

General Provider Information

NPI Number	:	1508728080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR MOHS AND SKIN SURGERY

Provider Business Mailing Address
First Line	:	8169 PRECINCT LINE RD BLDG 1
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8169 PRECINCT LINE RD BLDG 1
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8607
Country	:	US
Telephone Number	:	817-427-3376
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS DIRECTOR
Name	:	SARAH TRAN
Credential	:
Telephone Number	:	817-909-1907

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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