Provider Demographics
NPI:1790154102
Name:FORT WORTH INFECTIOUS DISEASE CONSULTANTS PLLC
Entity Type:Organization
Organization Name:FORT WORTH INFECTIOUS DISEASE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:KANTH
Authorized Official - Last Name:BOBBILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-877-4690
Mailing Address - Street 1:11803 SOUTH FWY STE 111
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7028
Mailing Address - Country:US
Mailing Address - Phone:817-349-9500
Mailing Address - Fax:817-349-9501
Practice Address - Street 1:11803 SOUTH FWY STE 111
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7028
Practice Address - Country:US
Practice Address - Phone:817-349-9500
Practice Address - Fax:817-349-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5578207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty