Provider Demographics
NPI:1407295710
Name:MIRCHANDANI, ANISH (DO)
Entity Type:Individual
Prefix:DR
First Name:ANISH
Middle Name:
Last Name:MIRCHANDANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11625 CUSTER RD STE 110-325
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8783
Mailing Address - Country:US
Mailing Address - Phone:469-757-7623
Mailing Address - Fax:469-757-7613
Practice Address - Street 1:1970 W UNIVERSITY DR STE 210
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8134
Practice Address - Country:US
Practice Address - Phone:469-757-7623
Practice Address - Fax:469-757-7613
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR21732081P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine