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General NPI Number Information
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NPI Number | 1578519856
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Entity Type | Individual
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Provider Name | SREEKUMARAN NAIR M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 915 S MAIN ST STE A
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City | FORT WORTH
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State | TX
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Zip | 76104-3408
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Country | US
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Telephone | 817-336-2026
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Fax | 817-336-5996
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Provider Business Mailing Address
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Address Line | 915 S MAIN ST STE A
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City | FORT WORTH
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State | TX
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Zip | 76104-3408
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Country | US
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Telephone | 817-336-2026
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Fax | 817-336-5996
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | J8071
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | J8071
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License Number State | TX
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