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General NPI Number Information
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NPI Number | 1700428331
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Entity Type | Organization
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Legal Business Name | STAR SURGICAL SERVICES
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 1631 LANCASTER DR STE 240
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City | GRAPEVINE
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State | TX
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Zip | 76051-3586
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Country | US
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Telephone | 817-741-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 405 STOCKTON DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-2229
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/PHYSICIAN
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Name | DR. SHARI KUSHWAHA
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Credential | MD
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Telephone | 817-312-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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