Healthcare Provider Details

I. General information

NPI: 1629189733
Provider Name (Legal Business Name): WHITEROCK ANESTHESIA CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9440 POPPY DRIVE
DALLAS TX
75218
US

IV. Provider business mailing address

PO BOX 870638
MESQUITE TX
75187-0638
US

V. Phone/Fax

Practice location:
  • Phone: 214-681-6100
  • Fax:
Mailing address:
  • Phone: 972-681-7246
  • Fax: 972-681-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAGARAJ S KIKKERI
Title or Position: OWNER
Credential: MD
Phone: 972-681-7246