MEDICARE: CHISATO NISHIKAWA MD

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
1	207Q00000X	Family Medicine Physician	U4289	TX

General Provider Information

NPI Number	:	1346861770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHISATO NISHIKAWA MD

Provider Business Mailing Address
First Line	:	10745 W GRAND PKWY S STE 200
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-8713
Country	:	US
Telephone Number	:	281-275-0130
Fax Number	:

Provider Business Practice Location Address
First Line	:	10745 W GRAND PKWY S
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-8711
Country	:	US
Telephone Number	:	281-275-0130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	12/13/2023

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