Provider Demographics
NPI:1669655817
Name:KANDPAL, SAURABH BASU (MD)
Entity Type:Individual
Prefix:DR
First Name:SAURABH
Middle Name:BASU
Last Name:KANDPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9555 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-6951
Mailing Address - Country:US
Mailing Address - Phone:915-800-1106
Mailing Address - Fax:915-800-1107
Practice Address - Street 1:9555 DIANA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6951
Practice Address - Country:US
Practice Address - Phone:915-800-1106
Practice Address - Fax:915-800-1107
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2832751Medicaid
OH7386381Medicare PIN