MEDICARE: DR. NEELAN S DOOLABH 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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	K1185	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	752616977107	OTHER	TX	TRICARE E LAKE STREET LOCATION
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	K1185	OTHER	TX	MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	752616977039	OTHER	TX	TRICARE NORTHPARK LOCATION
6	752616977110	OTHER	TX	TRICARE MAPS LOCATION
7	8AM683	OTHER	TX	BCBS
8	8J5071	OTHER	TX	BCBS PROVIDER

General Provider Information

NPI Number	:	1598789117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEELAN S DOOLABH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 S FLEISHEL AVE
Second Line	:	STE 5000
City	:	TYLER
State	:	TX
Zip	:	75701-2015
Country	:	US
Telephone Number	:	903-606-7525
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/13/2014

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