Healthcare Provider Details

I. General information

NPI: 1194858415
Provider Name (Legal Business Name): CKP NAIR, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 9TH AVE SUITE 202
FORT WORTH TX
76104-3903
US

IV. Provider business mailing address

909 9TH AVE SUITE 202
FORT WORTH TX
76104-3903
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-4105
  • Fax: 817-366-1409
Mailing address:
  • Phone: 817-877-4105
  • Fax: 817-366-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. CKP NAIR
Title or Position: OWNER
Credential: MD
Phone: 817-877-4105