Healthcare Provider Details

I. General information

NPI: 1407275712
Provider Name (Legal Business Name): INTERNATIONAL NEPHROLOGY CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 COPPERFIELD LN
PLANO TX
75023-3464
US

IV. Provider business mailing address

6549 COPPERFIELD LN
PLANO TX
75023-3464
US

V. Phone/Fax

Practice location:
  • Phone: 214-736-7969
  • Fax:
Mailing address:
  • Phone: 214-736-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDT80358
License Number StateTX

VIII. Authorized Official

Name: MR. VISHAL BAGCHI
Title or Position: REGISTERED DIETITIAN
Credential: R.D, L.D
Phone: 214-736-7969