Provider Demographics
NPI:1437161189
Name:VASANAWALA, KOKILA S (MD)
Entity Type:Individual
Prefix:DR
First Name:KOKILA
Middle Name:S
Last Name:VASANAWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 W VETERANS BLVD
Mailing Address - Street 2:WEST TEAXS VA HEALTH CARE SYSTEM
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-5566
Mailing Address - Country:US
Mailing Address - Phone:432-263-7361
Mailing Address - Fax:432-264-4859
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:WEST TEAXS VA HEALTH CARE SYSTEM
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:432-264-4859
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY134192-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134192-1OtherMEDICAL LINCENSE