MEDICARE: NEUROSCIENCE AND HEADACHE CENTER OF NORTH TEXAS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	N0488	TX

General Provider Information

NPI Number	:	1174986319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSCIENCE AND HEADACHE CENTER OF NORTH TEXAS, PLLC

Provider Business Mailing Address
First Line	:	9607 VALLEY LAKE LN
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-5014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9607 VALLEY LAKE LN
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-5014
Country	:	US
Telephone Number	:	469-323-8112
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMED SUMMAKIA
Credential	:	MD
Telephone Number	:	469-323-8112

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/04/2016

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