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General NPI Number Information
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NPI Number | 1508308768
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Entity Type | Organization
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Legal Business Name | SATYA P. KAUSHIK,M.D.,P.A
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 617 TRAVIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3153
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Country | US
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Telephone | 817-335-3279
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Fax | 817-335-7763
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Provider Business Mailing Address
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Address Line | 617 TRAVIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3153
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Country | US
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Telephone | 817-335-3279
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Fax | 817-335-7763
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SATYA PRAKASH KAUSHIK
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Credential | M.D.
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Telephone | 817-335-3279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G9608
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License Number State | TX
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