Healthcare Provider Details

I. General information

NPI: 1831209949
Provider Name (Legal Business Name): MESQUITE PROFESSIONAL ANESTHESIA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 CHILDRESS AVE
MESQUITE TX
75150-2802
US

IV. Provider business mailing address

PO BOX 870638
MESQUITE TX
75187-0638
US

V. Phone/Fax

Practice location:
  • Phone: 972-681-7246
  • Fax:
Mailing address:
  • Phone: 972-681-7246
  • Fax: 972-681-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAGARAJ S KIKKERI
Title or Position: OWNER
Credential: MD
Phone: 972-681-7246