Provider Demographics
NPI:1629280771
Name:KUDAKKASSERIL, ANUP S (MD)
Entity Type:Individual
Prefix:
First Name:ANUP
Middle Name:S
Last Name:KUDAKKASSERIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANUP
Other - Middle Name:
Other - Last Name:SKARIAKUDAKKASSERIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11811 FM 1960 RD W STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11811 FM 1960 RD W
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3827
Practice Address - Country:US
Practice Address - Phone:281-970-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0620208000000X
PAMD436049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics