Provider Demographics
NPI:1174008692
Name:STAR PEDIATRIC GROUP PLLC
Entity Type:Organization
Organization Name:STAR PEDIATRIC GROUP PLLC
Other - Org Name:STAR PEDIATRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSER
Authorized Official - Middle Name:
Authorized Official - Last Name:TASNEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-578-7866
Mailing Address - Street 1:PO BOX 3888
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4310
Mailing Address - Country:US
Mailing Address - Phone:718-578-7866
Mailing Address - Fax:
Practice Address - Street 1:541 W MAIN ST # 110
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3628
Practice Address - Country:US
Practice Address - Phone:718-578-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty