Provider Demographics
NPI:1124184247
Name:CROSS CREEK NEUROLOGY PLLC
Entity type:Organization
Organization Name:CROSS CREEK NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:AMIR
Authorized Official - Last Name:KHASRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-487-5574
Mailing Address - Street 1:3533 TURNBERRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4665
Mailing Address - Country:US
Mailing Address - Phone:910-487-5574
Mailing Address - Fax:910-487-5574
Practice Address - Street 1:518 BEAUMONT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4447
Practice Address - Country:US
Practice Address - Phone:910-487-5574
Practice Address - Fax:910-487-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891297AMedicaid
2349178Medicare PIN