Healthcare Provider Details

I. General information

NPI: 1629280771
Provider Name (Legal Business Name): ANUP S KUDAKKASSERIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANUP SKARIAKUDAKKASSERIL MD

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 FM 1960 RD W SUITE 100
HOUSTON TX
77065-3827
US

IV. Provider business mailing address

11811 FM 1960 RD W STE 100
HOUSTON TX
77065-3888
US

V. Phone/Fax

Practice location:
  • Phone: 281-970-2337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP0620
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD436049
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: