Provider Demographics
NPI:1962571091
Name:KATHPALIA, RAKESH K (MD)
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:K
Last Name:KATHPALIA
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-215-9722
Practice Address - Street 1:425 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1047
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:512-509-0285
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5274207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184058902Medicaid
H26451Medicare UPIN
TX8F4285Medicare PIN
TX8F4285Medicare ID - Type Unspecified