Provider Demographics
NPI:1841293164
Name:RAGHURAM, NANDKISHORE B (MD)
Entity type:Individual
Prefix:
First Name:NANDKISHORE
Middle Name:B
Last Name:RAGHURAM
Suffix:
Gender:M
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 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-5079
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1600 WALLACE BLVD
Practice Address - Street 2:2ND FLOOR, PICU
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-212-6965
Practice Address - Fax:806-212-6278
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6254207LP3000X, 2080P0203X
WI515882080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177246904Medicaid
TX177246904Medicaid
TX177246904Medicaid