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General NPI Number Information
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NPI Number | 1104243104
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Entity Type | Individual
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Provider Name | DR. KISHAN PRASAD TALAGADADEEVI
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Gender | Male
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1600 HOSPITAL PKWY
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City | BEDFORD
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State | TX
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Zip | 76022-6913
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Country | US
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Telephone | 817-848-2708
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Fax |
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Provider Business Mailing Address
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Address Line | 524 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5725
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Country | US
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Telephone | 337-436-2511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 305972
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | T5786
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License Number State | TX
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