Healthcare Provider Details

I. General information

NPI: 1326357666
Provider Name (Legal Business Name): NILADRI BASU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 05/06/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W. COLORADO BLVD. PAVILION II SUITE 933
DALLAS TX
75208
US

IV. Provider business mailing address

221 W. COLORADO BLVD. PAVILION II SUITE 933
DALLAS TX
75208
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-3684
  • Fax: 214-947-3686
Mailing address:
  • Phone: 214-947-3684
  • Fax: 214-947-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberS3117
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberS3117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: