Provider Demographics
NPI:1528222817
Name:KANDEL, ANUJ RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:RAJ
Last Name:KANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 FOREST CENTRAL DR
Mailing Address - Street 2:SUITE 133
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:214-343-8565
Mailing Address - Fax:214-342-3054
Practice Address - Street 1:2460 N I 35 STE 275
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5266
Practice Address - Country:US
Practice Address - Phone:214-343-8565
Practice Address - Fax:214-342-3054
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19198208C00000X
TXQ4154208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355153304Medicaid
TX355153305Medicaid
ME1528222817Medicaid