Provider Demographics
NPI:1962656801
Name:NAIR, SANJEEV UNNIKRISHNAN (MBBS, MD)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:UNNIKRISHNAN
Last Name:NAIR
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 8TH AVE STE 616
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2605
Mailing Address - Country:US
Mailing Address - Phone:817-577-7042
Mailing Address - Fax:817-527-8504
Practice Address - Street 1:909 9TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3932
Practice Address - Country:US
Practice Address - Phone:817-577-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047007207R00000X
TXR4605207R00000X, 207RC0000X, 207RI0011X
MI4301109241207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001470079Medicaid
TX377067904Medicaid