Healthcare Provider Details

I. General information

NPI: 1851910699
Provider Name (Legal Business Name): KOMAL PARIKH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2020
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

4810 104TH ST
LUBBOCK TX
79424-5761
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5101
  • Fax:
Mailing address:
  • Phone: 806-470-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036175079
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: