Provider Demographics
NPI:1619734993
Name:PRIME NEUROLOGY PLLC
Entity Type:Organization
Organization Name:PRIME NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-323-8112
Mailing Address - Street 1:9607 VALLEY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5014
Mailing Address - Country:US
Mailing Address - Phone:469-323-8112
Mailing Address - Fax:940-243-0404
Practice Address - Street 1:6800 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2422
Practice Address - Country:US
Practice Address - Phone:972-246-8563
Practice Address - Fax:940-243-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty