Provider Demographics
NPI:1972059392
Name:STAR MD, PLLC
Entity type:Organization
Organization Name:STAR MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:T
Authorized Official - Last Name:JYOTHINAGARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-698-2371
Mailing Address - Street 1:2201 LONG PRAIRIE RD
Mailing Address - Street 2:STE 107 PMB 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4964
Mailing Address - Country:US
Mailing Address - Phone:972-698-2371
Mailing Address - Fax:
Practice Address - Street 1:1011 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:214-320-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty