Provider Demographics
NPI:1073521027
Name:NORTH TEXAS NEUROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTH TEXAS NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARYOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KABOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-288-1038
Mailing Address - Street 1:1050 N BELTLINE
Mailing Address - Street 2:STE 103
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:972-288-1039
Mailing Address - Fax:972-288-1418
Practice Address - Street 1:1050 N BELTLINE
Practice Address - Street 2:STE 103
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-288-1038
Practice Address - Fax:972-288-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE86052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K58DMedicare ID - Type Unspecified