Healthcare Provider Details

I. General information

NPI: 1225049224
Provider Name (Legal Business Name): REKHA POLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W PLANO PKWY STE 100
PLANO TX
75093-4851
US

IV. Provider business mailing address

1820 PRESTON PARK BLVD STE 2500
PLANO TX
75093-3674
US

V. Phone/Fax

Practice location:
  • Phone: 972-733-7242
  • Fax: 972-403-1465
Mailing address:
  • Phone: 972-733-7242
  • Fax: 972-403-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG5490
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: