Healthcare Provider Details

I. General information

NPI: 1356722433
Provider Name (Legal Business Name): RK GASTROENTEROLOGY & HEPATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S BELT LINE RD
COPPELL TX
75019-4531
US

IV. Provider business mailing address

PO BOX 3551
COPPELL TX
75019-9551
US

V. Phone/Fax

Practice location:
  • Phone: 214-377-9845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: REHAN A KHAN
Title or Position: OWNER
Credential:
Phone: 972-393-7209