Healthcare Provider Details

I. General information

NPI: 1629521851
Provider Name (Legal Business Name): LAXMIDEEPIKA KOYA, M.D.,P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N VALLEY PKWY SUITE 111
LEWISVILLE TX
75067-3479
US

IV. Provider business mailing address

PO BOX 293717
LEWISVILLE TX
75029-3762
US

V. Phone/Fax

Practice location:
  • Phone: 214-888-0670
  • Fax: 972-221-3917
Mailing address:
  • Phone: 214-888-0670
  • Fax: 972-221-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP0746
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberP0746
License Number StateTX

VIII. Authorized Official

Name: DR. LAXMI DEEPIKA KOYA
Title or Position: DIRECTOR
Credential: M.D
Phone: 214-888-0670