Provider Demographics
NPI:1639321326
Name:KANSAGRA, KAVITA BHAGAWANJI (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:BHAGAWANJI
Last Name:KANSAGRA
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 1:584 N GERMANTOWN PKWY
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-5211
Mailing Address - Country:US
Mailing Address - Phone:901-753-7686
Mailing Address - Fax:901-753-2120
Practice Address - Street 1:584 N GERMANTOWN PKWY
Practice Address - Street 2:SUITE # 110
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-5211
Practice Address - Country:US
Practice Address - Phone:901-753-7686
Practice Address - Fax:901-753-2120
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7875097Medicaid
MS7875097Medicaid