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General NPI Number Information
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NPI Number | 1063575942
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Entity Type | Organization
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Legal Business Name | MESQUITE NEUROLOGY CLINIC PA
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 1320 N GALLOWAY AVE STE 101
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City | MESQUITE
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State | TX
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Zip | 75149-2461
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Country | US
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Telephone | 972-329-9001
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Fax | 972-279-9040
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Provider Business Mailing Address
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Address Line | 2698 N GALLOWAY AVE SUITE 102
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City | MESQUITE
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State | TX
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Zip | 75150-6383
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Country | US
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Telephone | 972-329-9001
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Fax | 972-279-9040
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LUTFI BASATNEH
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Credential | M.D.
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Telephone | 972-329-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K3984
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License Number State | TX
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