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General NPI Number Information
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NPI Number | 1316554413
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY MD PLLC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 7500 DAVIS BLVD STE 100
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76182-7402
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Country | US
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Telephone | 817-893-6001
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Fax | 817-479-8668
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Provider Business Mailing Address
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Address Line | 7500 DAVIS BLVD STE 100
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76182-7402
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Country | US
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Telephone | 817-893-6001
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Fax | 817-479-8668
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Authorized Official
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Title or Position | DERMATOLOGIST/MANAGER
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Name | SHAILY PATEL KESANI
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Credential | MD
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Telephone | 312-543-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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