Healthcare Provider Details

I. General information

NPI: 1972059392
Provider Name (Legal Business Name): STAR MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N GALLOWAY AVE
MESQUITE TX
75149
US

IV. Provider business mailing address

2201 LONG PRAIRIE RD STE 107 PMB 300
FLOWER MOUND TX
75022-4964
US

V. Phone/Fax

Practice location:
  • Phone: 214-320-7000
  • Fax:
Mailing address:
  • Phone: 972-698-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: SRIKANTH T JYOTHINAGARAM
Title or Position: PRESIDENT
Credential: MD
Phone: 972-698-2371