Provider Demographics
NPI:1316226418
Name:LONESTAR HOUSECALL PHYSICIANS PLLC
Entity Type:Organization
Organization Name:LONESTAR HOUSECALL PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-893-9613
Mailing Address - Street 1:8150 BROOKRIVER DR STE 303
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4055
Mailing Address - Country:US
Mailing Address - Phone:469-893-9613
Mailing Address - Fax:214-774-2367
Practice Address - Street 1:8150 BROOKRIVER DR STE 303
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4055
Practice Address - Country:US
Practice Address - Phone:469-893-9613
Practice Address - Fax:214-774-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39523Medicare UPIN