Provider Demographics
NPI:1366153223
Name:LONESTAR PODIATRY PLLC
Entity type:Organization
Organization Name:LONESTAR PODIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-557-6129
Mailing Address - Street 1:705 E BROAD ST STE 117
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6914
Mailing Address - Country:US
Mailing Address - Phone:817-697-4840
Mailing Address - Fax:817-753-8985
Practice Address - Street 1:705 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6913
Practice Address - Country:US
Practice Address - Phone:817-697-4840
Practice Address - Fax:817-753-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric