Healthcare Provider Details

I. General information

NPI: 1992811657
Provider Name (Legal Business Name): LONE STAR INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 CLARA BARTON BLVD
GARLAND TX
75042-5756
US

IV. Provider business mailing address

617 CLARA BARTON BLVD
GARLAND TX
75042-5756
US

V. Phone/Fax

Practice location:
  • Phone: 972-485-4440
  • Fax: 972-485-4443
Mailing address:
  • Phone: 972-485-4440
  • Fax: 972-485-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberM1573
License Number StateTX

VIII. Authorized Official

Name: MR. RANJAN CHANDA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 972-485-4440