Provider Demographics
NPI:1316554413
Name:DERMATOLOGY MD PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAILY
Authorized Official - Middle Name:PATEL
Authorized Official - Last Name:KESANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-543-0510
Mailing Address - Street 1:7500 DAVIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-7402
Mailing Address - Country:US
Mailing Address - Phone:817-893-6001
Mailing Address - Fax:817-479-8668
Practice Address - Street 1:7500 DAVIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-7402
Practice Address - Country:US
Practice Address - Phone:817-893-6001
Practice Address - Fax:817-479-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty