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General NPI Number Information
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NPI Number | 1174008692
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Entity Type | Organization
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Legal Business Name | STAR PEDIATRIC GROUP PLLC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 541 W MAIN ST # 110
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City | LEWISVILLE
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State | TX
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Zip | 75057-3628
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Country | US
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Telephone | 718-578-7866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3888
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City | COPPELL
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State | TX
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Zip | 75019-4310
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Country | US
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Telephone | 718-578-7866
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. AFSER TASNEEM
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Credential | MD
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Telephone | 718-578-7866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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