Healthcare Provider Details

I. General information

NPI: 1447227483
Provider Name (Legal Business Name): NISHI KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 AIRPORT FWY STE 220
BEDFORD TX
76021
US

IV. Provider business mailing address

1305 AIRPORT FWY STE 220
BEDFORD TX
76021-6606
US

V. Phone/Fax

Practice location:
  • Phone: 817-857-6565
  • Fax: 817-283-7686
Mailing address:
  • Phone: 817-857-6565
  • Fax: 817-283-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number043391
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR5152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: