Healthcare Provider Details

I. General information

NPI: 1487008777
Provider Name (Legal Business Name): NIDHI PARIKH KUDUR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIDHI R PARIKH DO

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 BANDERA RD
SAN ANTONIO TX
78250
US

IV. Provider business mailing address

10350 BANDERA RD
SAN ANTONIO TX
78250-5615
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-6530
  • Fax:
Mailing address:
  • Phone: 210-450-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberS1157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: