Provider Demographics
NPI:1811705585
Name:ADVANCED TEXAS NEUROLOGY LLC
Entity type:Organization
Organization Name:ADVANCED TEXAS NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AKM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKTADIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-333-9475
Mailing Address - Street 1:301 AUTUMN HL
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 TALON DR STE 300
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9720
Practice Address - Country:US
Practice Address - Phone:901-333-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty