Provider Demographics
NPI:1760619621
Name:NIRMAL, KAVITA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:NIRMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GOUD
Other - Middle Name:KAVITA
Other - Last Name:NIRMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:815 S WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5316
Practice Address - Country:US
Practice Address - Phone:903-927-6094
Practice Address - Fax:903-927-6095
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3211207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00868147OtherRAILROAD MEDICARE
TX212469501Medicaid
TXP00868147OtherRAILROAD MEDICARE