Provider Demographics
NPI:1518291574
Name:KUNIYIL, JESHEEJA (MD)
Entity Type:Individual
Prefix:
First Name:JESHEEJA
Middle Name:
Last Name:KUNIYIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 GALAXIE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-4502
Mailing Address - Country:US
Mailing Address - Phone:214-221-6362
Mailing Address - Fax:214-345-8784
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4426
Practice Address - Country:US
Practice Address - Phone:214-221-6362
Practice Address - Fax:214-345-8784
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259185207R00000X
TXP1095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303038901Medicaid
TX303038901Medicaid