Provider Demographics
NPI:1043389042
Name:DEKA, KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:
Last Name:DEKA
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 1:6121 HILLCROFT ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1002
Mailing Address - Country:US
Mailing Address - Phone:713-995-6776
Mailing Address - Fax:
Practice Address - Street 1:6121 HILLCROFT ST
Practice Address - Street 2:SUITE J
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1002
Practice Address - Country:US
Practice Address - Phone:713-995-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80X064OtherBLUE CROSS BLUE SHIELDS
TX00T59TMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX80X064OtherBLUE CROSS BLUE SHIELDS