Provider Demographics
NPI:1154405116
Name:DHARMASHANKAR, KODLIPET (MD)
Entity type:Individual
Prefix:
First Name:KODLIPET
Middle Name:
Last Name:DHARMASHANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KODLIPET
Other - Middle Name:
Other - Last Name:DHARMASHANKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6807 EMMETT F. LOWRY EXPY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591
Mailing Address - Country:US
Mailing Address - Phone:409-945-5444
Mailing Address - Fax:409-945-4133
Practice Address - Street 1:6807 EMMETT F LOWRY EXPY
Practice Address - Street 2:SUITE 108
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2546
Practice Address - Country:US
Practice Address - Phone:409-945-5444
Practice Address - Fax:409-945-4133
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45787207R00000X
FLME102151207R00000X
TXP9324207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352395301Medicaid
H87537Medicare UPIN
TX352395301Medicaid