Provider Demographics
NPI:1104854926
Name:GHOSH, KIRAT SANTANU (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAT
Middle Name:SANTANU
Last Name:GHOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13350 TI BLVD
Mailing Address - Street 2:MS327
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1512
Mailing Address - Country:US
Mailing Address - Phone:972-671-9504
Mailing Address - Fax:972-671-7096
Practice Address - Street 1:13350 TI BLVD
Practice Address - Street 2:M/S 327
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1512
Practice Address - Country:US
Practice Address - Phone:972-671-9504
Practice Address - Fax:972-671-7096
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8F3456OtherBCBS
TX080184128OtherRR MEDICARE
TX080184128OtherRR MEDICARE
TX8163B4Medicare ID - Type Unspecified