Provider Demographics
NPI:1578519856
Name:NAIR, SREEKUMARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEKUMARAN
Middle Name:
Last Name:NAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SREEKUMARAN
Other - Middle Name:
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:915 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3408
Mailing Address - Country:US
Mailing Address - Phone:817-336-2026
Mailing Address - Fax:817-336-5996
Practice Address - Street 1:915 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3408
Practice Address - Country:US
Practice Address - Phone:817-336-2026
Practice Address - Fax:817-336-5996
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8071174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1136426-02Medicaid
TX00656DOtherBLUE CROSS BLUE SHIELD
TX10028895OtherAMERIGROUP
TX75043OtherAMERICAID
TX75043OtherAMERICAID
TXE13828Medicare UPIN