Provider Demographics
NPI:1942411889
Name:NAIR, AMBIKA K (MD)
Entity Type:Individual
Prefix:
First Name:AMBIKA
Middle Name:K
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBIKA
Other - Middle Name:KUMARI
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1227 WOODSEY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9758
Mailing Address - Country:US
Mailing Address - Phone:817-416-1467
Mailing Address - Fax:214-540-6627
Practice Address - Street 1:1617 HEMPHILL STREET
Practice Address - Street 2:
Practice Address - City:FORTWORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7911
Practice Address - Country:US
Practice Address - Phone:817-927-1395
Practice Address - Fax:817-927-3603
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN17942084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L17376OtherMEDICARE PROVIDER NUMBER
TX206145901Medicaid