Healthcare Provider Details

I. General information

NPI: 1700968740
Provider Name (Legal Business Name): SENTHIL KUMAR THAMBIDORAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W ROSEDALE ST STE 105
FORT WORTH TX
76104-7400
US

IV. Provider business mailing address

1650 W ROSEDALE ST STE 105
FORT WORTH TX
76104-7400
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-4822
  • Fax: 972-566-4170
Mailing address:
  • Phone: 972-566-4822
  • Fax: 972-566-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberN8585
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberN8585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: