MEDICARE: HARESHKUMAR D BOGHARA 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	207Q00000X	Family Medicine Physician	P4289	TX

General Provider Information

NPI Number	:	1962660589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARESHKUMAR D BOGHARA M.D.

Provider Business Mailing Address
First Line	:	951 YORK DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2052
Country	:	US
Telephone Number	:	972-777-6956
Fax Number	:	972-777-6922

Provider Business Practice Location Address
First Line	:	935 YORK DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2043
Country	:	US
Telephone Number	:	972-777-6956
Fax Number	:	972-777-6922

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	04/01/2024

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