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General NPI Number Information
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NPI Number | 1790154102
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Entity Type | Organization
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Legal Business Name | FORT WORTH INFECTIOUS DISEASE CONSULTANTS PLLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 11803 SOUTH FWY STE 111
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City | BURLESON
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State | TX
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Zip | 76028-7028
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Country | US
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Telephone | 817-349-9500
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Fax | 817-349-9501
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Provider Business Mailing Address
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Address Line | 11803 SOUTH FWY STE 111
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City | BURLESON
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State | TX
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Zip | 76028-7028
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Country | US
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Telephone | 817-349-9500
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Fax | 817-349-9501
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISHNA KANTH BOBBILI
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Credential | MD
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Telephone | 704-877-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | N5578
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License Number State | TX
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