Provider Demographics
NPI:1225647423
Name:FIVESTAR PULMONARY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:FIVESTAR PULMONARY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EGUAKHIDE
Authorized Official - Last Name:NEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-561-0064
Mailing Address - Street 1:981 STATE HIGHWAY 121 STE 3100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6149
Mailing Address - Country:US
Mailing Address - Phone:972-526-0007
Mailing Address - Fax:888-905-2543
Practice Address - Street 1:981 STATE HWY 121
Practice Address - Street 2:STE 3100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-526-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty