Provider Demographics
NPI:1063671865
Name:SATISH, NISHA (MD)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:SATISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261092
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-1092
Mailing Address - Country:US
Mailing Address - Phone:972-232-7474
Mailing Address - Fax:972-232-7401
Practice Address - Street 1:4501 JOE RAMSEY BLVD E
Practice Address - Street 2:STE. 260
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7836
Practice Address - Country:US
Practice Address - Phone:972-232-7474
Practice Address - Fax:972-232-7401
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403949ZNF9Medicare PIN