Provider Demographics
NPI:1891754131
Name:KOGANTI, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:KOGANTI
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 1:3409 WORTH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:214-820-8350
Mailing Address - Fax:214-820-8355
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-820-8350
Practice Address - Fax:214-820-8355
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1842207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M2956OtherBCBS
TX176308803Medicaid
TX176308801Medicaid
TX176308803Medicaid
TX8L2183Medicare PIN
TXP00694362Medicare PIN
TX176308801Medicaid