Healthcare Provider Details

I. General information

NPI: 1306959341
Provider Name (Legal Business Name): LALIT KUMAR MAHAJAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N I-35
DENTON TX
76201-5119
US

IV. Provider business mailing address

3000 N I-35
DENTON TX
76201-5119
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21733
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN8683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: