Healthcare Provider Details

I. General information

NPI: 1528232667
Provider Name (Legal Business Name): ALOK KUSHWAHA, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 LANCASTER DR STE 201
GRAPEVINE TX
76051-3593
US

IV. Provider business mailing address

4029 EDGEWATER CT
RICHARDSON TX
75082-5606
US

V. Phone/Fax

Practice location:
  • Phone: 972-510-5150
  • Fax: 972-852-9094
Mailing address:
  • Phone: 972-510-5150
  • Fax: 972-852-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberK1232
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberK1232
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK1232
License Number StateTX

VIII. Authorized Official

Name: DR. ALOK P KUSHWAHA
Title or Position: CEO
Credential: MD
Phone: 972-510-5150