Provider Demographics
NPI:1063831204
Name:KHANDAI, ABHISEK C (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:ABHISEK
Middle Name:C
Last Name:KHANDAI
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:469-419-9606
Practice Address - Fax:214-267-1632
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250655922084P0800X
TX472872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry