Provider Demographics
NPI:1710331681
Name:SINGH, MAHESHWARDEEP (DO)
Entity Type:Individual
Prefix:DR
First Name:MAHESHWARDEEP
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6210 E US HWY 290
Mailing Address - Street 2:SUITE 420
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1098
Mailing Address - Country:US
Mailing Address - Phone:512-231-5507
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:4100 EVERETT DR STE 400
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6147
Practice Address - Country:US
Practice Address - Phone:512-295-1333
Practice Address - Fax:512-406-7327
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403926502Medicaid
TX403926501Medicaid