MEDICARE: NEURO CARE LLC

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician

General Provider Information

NPI Number	:	1659145100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO CARE LLC

Provider Business Mailing Address
First Line	:	3600 NORTHSTAR RD STE 140
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-5309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2408 E 81ST ST STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-4215
Country	:	US
Telephone Number	:	539-666-0919
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FARID UD DIN
Credential	:	MD
Telephone Number	:	539-666-0919

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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