Provider Demographics
NPI:1104957646
Name:NUCARE PA
Entity type:Organization
Organization Name:NUCARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:SUDEEP
Authorized Official - Last Name:RAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-208-2900
Mailing Address - Street 1:2105 W SPRING CREEK PKWY STE A300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4195
Mailing Address - Country:US
Mailing Address - Phone:972-208-2900
Mailing Address - Fax:972-492-6750
Practice Address - Street 1:2105 W SPRING CREEK PKWY STE A300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4195
Practice Address - Country:US
Practice Address - Phone:972-208-2900
Practice Address - Fax:972-492-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5511261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JS59Medicare PIN