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General NPI Number Information
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NPI Number | 1396745311
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Entity Type | Individual
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Provider Name | NAGARAJ S KIKKERI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2005
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 3865 CHILDRESS AVE SUITE A
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City | MESQUITE
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State | TX
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Zip | 75150-2802
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Country | US
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Telephone | 972-681-7246
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Fax | 972-681-8946
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Provider Business Mailing Address
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Address Line | 3865 CHILDRESS AVE SUITE A
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City | MESQUITE
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State | TX
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Zip | 75150-2802
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Country | US
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Telephone | 972-681-7246
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Fax | 972-681-8946
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | K9584
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | K9584
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License Number State | TX
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