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NPI Code Detail

MEDICARE: SUSAN KHANDELWAL M.D.

MEDICARE: SUSAN KHANDELWAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianL8761TX

General Provider Information

NPI Number : 1326064924
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN KHANDELWAL M.D.
Provider Business Mailing Address
First Line : PO BOX 841969
Second Line :
City : DALLAS
State : TX
Zip : 75284-1969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 740 GULFGATE CENTER MALL
Second Line :
City : HOUSTON
State : TX
Zip : 77087-3026
Country : US
Telephone Number : 713-514-8060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 08/30/2012

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