Provider Demographics
NPI:1053506774
Name:THUKRAL, NANDISH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDISH
Middle Name:KUMAR
Last Name:THUKRAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:4411 MEDICAL DR
Practice Address - Street 2:300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3822
Practice Address - Country:US
Practice Address - Phone:210-614-5400
Practice Address - Fax:210-614-2413
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM4590207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218677701Medicaid
TX8CN217OtherBCBS
TXP00898289OtherRAILROAD MEDICARE
TXTXB112455OtherMEDICARE
TXB112455Medicare PIN