Provider Demographics
NPI:1952859126
Name:DIVALI DOCS, PLLC
Entity Type:Organization
Organization Name:DIVALI DOCS, PLLC
Other - Org Name:MINIMALLY INVASIVE SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKREJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-399-7360
Mailing Address - Street 1:1411 N BECKLEY AVE STE 454
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1262
Mailing Address - Country:US
Mailing Address - Phone:469-620-0222
Mailing Address - Fax:469-620-0223
Practice Address - Street 1:1411 N BECKLEY AVE STE 454
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1262
Practice Address - Country:US
Practice Address - Phone:469-620-0222
Practice Address - Fax:469-620-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5098208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty