Provider Demographics
NPI:1942736525
Name:NORTH STAR MED, P.A.
Entity Type:Organization
Organization Name:NORTH STAR MED, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUKUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-483-0600
Mailing Address - Street 1:4645 WYNDHAM LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4645 WYNDHAM LN
Practice Address - Street 2:SUITE 230
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0004
Practice Address - Country:US
Practice Address - Phone:972-483-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9682207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty