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NPI Code Detail

MEDICARE: DR. ROUZBEH K KORDESTANI MD PA

MEDICARE:  DR. ROUZBEH K KORDESTANI  MD PA
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
1207XS0106XOrthopaedic Hand Surgery PhysicianM0133TX
22086S0122XPlastic and Reconstructive Surgery PhysicianM0133TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427039130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROUZBEH K KORDESTANI MD PA
Provider Business Mailing Address
First Line : 3501 SONCY
Second Line : SUITE 137
City : AMARILLO
State : TX
Zip : 79119-4932
Country : US
Telephone Number : 806-322-5438
Fax Number : 806-322-5505
Provider Business Practice Location Address
First Line : 3501 SONCY
Second Line : SUITE 137
City : AMARILLO
State : TX
Zip : 79119-4932
Country : US
Telephone Number : 806-322-5438
Fax Number : 806-322-5505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 03/25/2015

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