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NPI Code Detail

MEDICARE: ADVANCED TEXAS NEUROLOGY LLC

MEDICARE: ADVANCED TEXAS NEUROLOGY 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
12084N0400XNeurology Physician

General Provider Information

NPI Number : 1811705585
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED TEXAS NEUROLOGY LLC
Provider Business Mailing Address
First Line : 301 AUTUMN HL
Second Line :
City : MURPHY
State : TX
Zip : 75094-4436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 TALON DR STE 300
Second Line :
City : RICHARDSON
State : TX
Zip : 75082-9720
Country : US
Telephone Number : 901-333-9475
Fax Number :
Authorized Official
Title or Position : MD
Name : AKM MUKTADIR
Credential :
Telephone Number : 901-333-9475
Provider Enumeration Date : 12/26/2024
Last Update Date : 12/26/2024

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Directions to “ADVANCED TEXAS NEUROLOGY LLC ” Practice Location

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