Provider Demographics
NPI:1033307368
Name:PHASES OF LIFE WOMENS HEALTH CARE, PA
Entity Type:Organization
Organization Name:PHASES OF LIFE WOMENS HEALTH CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-4777
Mailing Address - Street 1:7999 WEST VIRGINIA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2041
Mailing Address - Country:US
Mailing Address - Phone:972-296-4777
Mailing Address - Fax:972-296-5499
Practice Address - Street 1:7999 WEST VIRGINIA
Practice Address - Street 2:SUITE A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2041
Practice Address - Country:US
Practice Address - Phone:972-296-4777
Practice Address - Fax:972-296-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0362279-02Medicaid
TX0362279-02Medicaid