Provider Demographics
NPI:1164804068
Name:DWIVEDI, KATYAYAN (MD)
Entity Type:Individual
Prefix:
First Name:KATYAYAN
Middle Name:
Last Name:DWIVEDI
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 1:2900 N INTERSTATE 35 STE 118
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5143
Mailing Address - Country:US
Mailing Address - Phone:940-380-8100
Mailing Address - Fax:
Practice Address - Street 1:2900 N INTERSTATE 35 STE 118
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5143
Practice Address - Country:US
Practice Address - Phone:940-380-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067713207R00000X
IN01080795A207R00000X
TXS5364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine