Provider Demographics
NPI:1013013192
Name:NANDEESHWAR, PALLAVI (MD)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:NANDEESHWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3394
Mailing Address - Country:US
Mailing Address - Phone:972-547-9700
Mailing Address - Fax:866-597-2559
Practice Address - Street 1:1445 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3394
Practice Address - Country:US
Practice Address - Phone:972-547-9700
Practice Address - Fax:972-547-1110
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7357207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH52814Medicare UPIN
TX6205090001Medicare NSC