MEDICARE: AJAY KADAKKAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	MD045548	DC

General Provider Information

NPI Number	:	1669614913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJAY KADAKKAL MD

Provider Business Mailing Address
First Line	:	P.O. BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-648-9741
Fax Number	:	214-648-9531

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-648-9741
Fax Number	:	214-648-9531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	06/08/2023

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