Provider Demographics
NPI:1639524143
Name:KAISANI, AFSHA (MD)
Entity Type:Individual
Prefix:
First Name:AFSHA
Middle Name:
Last Name:KAISANI
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 1:4927 LAKE RIDGE PKWY, STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:469-506-1671
Mailing Address - Fax:833-933-0652
Practice Address - Street 1:4927 LAKE RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:469-506-1671
Practice Address - Fax:833-633-0652
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS3049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program