Healthcare Provider Details

I. General information

NPI: 1407295710
Provider Name (Legal Business Name): ANISH MIRCHANDANI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 W UNIVERSITY DR STE 210
PROSPER TX
75078-8134
US

IV. Provider business mailing address

11625 CUSTER RD STE 110-325
FRISCO TX
75035-8783
US

V. Phone/Fax

Practice location:
  • Phone: 469-757-7623
  • Fax: 469-757-7613
Mailing address:
  • Phone: 469-757-7623
  • Fax: 469-757-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberR2173
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: