Provider Demographics
NPI:1164429668
Name:KAUSHIK, SATYA PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:SATYA
Middle Name:PRAKASH
Last Name:KAUSHIK
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 1:617 TRAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3153
Mailing Address - Country:US
Mailing Address - Phone:817-335-3270
Mailing Address - Fax:817-335-7763
Practice Address - Street 1:617 TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3153
Practice Address - Country:US
Practice Address - Phone:817-335-3270
Practice Address - Fax:817-335-7763
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127006801Medicaid
TX127006804Medicaid