Healthcare Provider Details

I. General information

NPI: 1851771976
Provider Name (Legal Business Name): RANJITH KASANAGOTTU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

5323 HARRY HINES BLVD STOP 7200
DALLAS TX
75390-7200
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-5930
  • Fax:
Mailing address:
  • Phone: 214-456-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD84563
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU6267
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: