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General NPI Number Information
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NPI Number | 1366299976
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Entity Type | Organization
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Legal Business Name | LUNAR MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 05/01/2024
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1111 RAINTREE CIR STE 290
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City | ALLEN
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State | TX
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Zip | 75013-4905
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Country | US
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Telephone | 469-342-3383
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Fax | 469-519-0213
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Provider Business Mailing Address
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Address Line | 1111 RAINTREE CIR STE 290
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City | ALLEN
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State | TX
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Zip | 75013-4905
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Country | US
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Telephone | 469-342-3383
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Fax | 469-519-0213
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Authorized Official
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Title or Position | PA
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Name | ALEXANDER P BULAN
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Credential | PHYSICIAN ASSISTANT
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Telephone | 469-342-3383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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