Provider Demographics
NPI:1942285671
Name:AGRAWAL, KANTI L (MD)
Entity Type:Individual
Prefix:
First Name:KANTI
Middle Name:L
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CLARA BARTON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5752
Mailing Address - Country:US
Mailing Address - Phone:972-487-1117
Mailing Address - Fax:972-494-2082
Practice Address - Street 1:530 CLARA BARTON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5752
Practice Address - Country:US
Practice Address - Phone:972-487-1117
Practice Address - Fax:972-494-2082
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8388207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8690OtherBCBS
TX134242008Medicaid
TX60064125Medicare PIN
B20805Medicare UPIN
TX134242008Medicaid