Provider Demographics
NPI:1083617997
Name:WINDISCH, KEVIN MERLE (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MERLE
Last Name:WINDISCH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ALMA DR STE 580
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7009
Mailing Address - Country:US
Mailing Address - Phone:469-344-1414
Mailing Address - Fax:
Practice Address - Street 1:1700 ALMA DR STE 580
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7009
Practice Address - Country:US
Practice Address - Phone:469-344-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR11522080P0006X
NV9023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016843Medicaid
NV3116843Medicaid