Provider Demographics
NPI:1073924502
Name:NORTH DALLAS NEUROLOGY, PLLC
Entity Type:Organization
Organization Name:NORTH DALLAS NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SAADAT
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-632-6031
Mailing Address - Street 1:6200 BLAIN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3097
Mailing Address - Country:US
Mailing Address - Phone:972-200-1272
Mailing Address - Fax:972-890-9159
Practice Address - Street 1:4112 W 15TH ST
Practice Address - Street 2:100B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5862
Practice Address - Country:US
Practice Address - Phone:972-200-1272
Practice Address - Fax:972-890-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM36112084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362831Medicare PIN