Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | K1931 | TX |
NPI | 1003893397 |
---|---|
Provider Name | Dr. Kamlesh J. Sisodiya |
First Address | Plano, TX 75075-7648 |
Second Address | Colleyville, TX 76034-5929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127663610 | (05) | TX |
8EL145 | BCBS (01) | TX |
F88548 | (02) | |
P01356074 | RR (01) | TX |