Provider Demographics
NPI:1376748590
Name:KHAZANCHI, KAMLA PUNWANI (MD)
Entity Type:Individual
Prefix:MRS
First Name:KAMLA
Middle Name:PUNWANI
Last Name:KHAZANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KAMLA
Other - Middle Name:METHARAM PUNWANI
Other - Last Name:KHAZANCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:605 MILTON
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3446
Mailing Address - Country:US
Mailing Address - Phone:979-849-1311
Mailing Address - Fax:979-849-1311
Practice Address - Street 1:605 MILTON
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3446
Practice Address - Country:US
Practice Address - Phone:979-849-1311
Practice Address - Fax:979-849-1311
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D66735Medicare UPIN
P000HA946Medicare ID - Type Unspecified