Healthcare Provider Details

I. General information

NPI: 1568200160
Provider Name (Legal Business Name): SEEMA A KUDSIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NORTHPOINT DR
COPPELL TX
75019-3831
US

IV. Provider business mailing address

1111 NORTHPOINT DRIVE ATTN: CREDENTILAING DEPARTMENT
COPPELL TX
75019
US

V. Phone/Fax

Practice location:
  • Phone: 615-562-9689
  • Fax: 972-966-7899
Mailing address:
  • Phone: 615-562-9689
  • Fax: 972-966-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number12345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: