Healthcare Provider Details

I. General information

NPI: 1245892017
Provider Name (Legal Business Name): MUSTANG HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STONEBROOK PKWY UNIT 201
FRISCO TX
75036-1181
US

IV. Provider business mailing address

400 STONEBROOK PKWY UNIT 201
FRISCO TX
75036-1181
US

V. Phone/Fax

Practice location:
  • Phone: 214-387-1888
  • Fax: 214-387-1889
Mailing address:
  • Phone: 214-387-1888
  • Fax: 214-387-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS BARTELEMY
Title or Position: OWNER
Credential:
Phone: 954-204-3977