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General NPI Number Information
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NPI Number | 1619734993
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Entity Type | Organization
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Legal Business Name | PRIME NEUROLOGY PLLC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 6800 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75039-2422
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Country | US
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Telephone | 972-246-8563
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Fax | 940-243-0404
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Provider Business Mailing Address
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Address Line | 9607 VALLEY LAKE LN
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City | IRVING
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State | TX
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Zip | 75063-5014
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Country | US
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Telephone | 469-323-8112
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Fax | 940-243-0404
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MOHAMED SUMMAKIA
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Credential | MD
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Telephone | 469-323-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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