Provider Demographics
NPI:1306089305
Name:DEWAN, ASHVIN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ASHVIN
Middle Name:KUMAR
Last Name:DEWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:281-565-8808
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:281-565-8808
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002054207X00000X
TXQ5643207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351536303Medicaid
TX8FK316OtherBLUE CROSS BLUE SHIELD
TX351536301Medicaid
TX8FX379OtherBLUE CROSS BLUE SHIELD
TX444884YMVQMedicare PIN
TX351536303Medicaid
TX444884YQ64Medicare PIN
TX8FK316OtherBLUE CROSS BLUE SHIELD