Healthcare Provider Details

I. General information

NPI: 1366616583
Provider Name (Legal Business Name): KISHORE GADIKOTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 W SPRING CREEK PKWY STE 200
PLANO TX
75024-4175
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 214-473-2200
  • Fax:
Mailing address:
  • Phone: 606-430-2230
  • Fax: 606-437-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47119
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18839
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR9062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: