Provider Demographics
NPI:1669438552
Name:PILLAY, PREM S (MD)
Entity Type:Individual
Prefix:
First Name:PREM
Middle Name:S
Last Name:PILLAY
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 1:1601 N BELT LINE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1791
Mailing Address - Country:US
Mailing Address - Phone:972-279-3500
Mailing Address - Fax:972-279-3505
Practice Address - Street 1:1601 N BELT LINE RD STE C
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1791
Practice Address - Country:US
Practice Address - Phone:972-279-3500
Practice Address - Fax:972-279-3505
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2754207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177963903Medicaid
TXP00286291OtherRAILROAD MEDICARE
TX177963904Medicaid
TX0008NGOtherBCBS
TX177963901Medicaid
612100Medicare PIN
TX324720YKQLMedicare PIN
E50031Medicare UPIN
TX177963904Medicaid