Provider Demographics
NPI:1679060800
Name:BLUE STAR DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:BLUE STAR DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-347-1100
Mailing Address - Street 1:301 N PRESTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8878
Mailing Address - Country:US
Mailing Address - Phone:972-347-1100
Mailing Address - Fax:
Practice Address - Street 1:301 N PRESTON RD STE D
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8878
Practice Address - Country:US
Practice Address - Phone:972-347-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty