Provider Demographics
NPI:1679737969
Name:JOSHI, JITESH (MD)
Entity Type:Individual
Prefix:DR
First Name:JITESH
Middle Name:
Last Name:JOSHI
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 1:2060 SPACE PARK DR STE 112
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3674
Mailing Address - Country:US
Mailing Address - Phone:832-783-1190
Mailing Address - Fax:
Practice Address - Street 1:2060 SPACE PARK DR STE 112
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3674
Practice Address - Country:US
Practice Address - Phone:832-783-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8600207RH0003X
TXR2371207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR2371OtherTEXAS MEDICAL BOARD
TX373124201Medicaid
ARE8600OtherARKANSAS MEDICAL BOARD