MEDICARE: LAXMIDEEPIKA KOYA, M.D.,P.A

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	207R00000X	Internal Medicine Physician	P0746	TX
2	207RG0100X	Gastroenterology Physician	P0746	TX

General Provider Information

NPI Number	:	1629521851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAXMIDEEPIKA KOYA, M.D.,P.A

Provider Business Mailing Address
First Line	:	PO BOX 293717
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75029-3762
Country	:	US
Telephone Number	:	214-888-0670
Fax Number	:	972-221-3917

Provider Business Practice Location Address
First Line	:	500 N VALLEY PKWY
Second Line	:	SUITE 111
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3479
Country	:	US
Telephone Number	:	214-888-0670
Fax Number	:	972-221-3917

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LAXMI DEEPIKA KOYA
Credential	:	M.D
Telephone Number	:	214-888-0670

Provider Enumeration Date	:	07/23/2016
Last Update Date	:	10/04/2016

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