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General NPI Number Information
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NPI Number | 1992811657
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Entity Type | Organization
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Legal Business Name | LONE STAR INTERNAL MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 617 CLARA BARTON BLVD
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City | GARLAND
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State | TX
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Zip | 75042-5756
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Country | US
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Telephone | 972-485-4440
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Fax | 972-485-4443
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Provider Business Mailing Address
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Address Line | 617 CLARA BARTON BLVD
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City | GARLAND
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State | TX
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Zip | 75042-5756
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Country | US
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Telephone | 972-485-4440
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Fax | 972-485-4443
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. RANJAN CHANDA
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Credential | M.D.
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Telephone | 972-485-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | M1573
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License Number State | TX
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