Healthcare Provider Details

I. General information

NPI: 1871093195
Provider Name (Legal Business Name): LONE STAR MED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E OSBORN RD
SCOTTSDALE AZ
85251-6432
US

IV. Provider business mailing address

5110 N 44TH ST STE L200
PHOENIX AZ
85018-1675
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4000
  • Fax:
Mailing address:
  • Phone: 602-343-2900
  • Fax: 602-532-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VIKRAM DEKA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 480-221-1162