Provider Demographics
NPI:1972970143
Name:SHAILY KESANI, PLLC
Entity Type:Organization
Organization Name:SHAILY KESANI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAILY
Authorized Official - Middle Name:PATEL
Authorized Official - Last Name:KESANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-543-0510
Mailing Address - Street 1:4471 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1795
Mailing Address - Country:US
Mailing Address - Phone:972-316-4555
Mailing Address - Fax:972-316-4550
Practice Address - Street 1:4471 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1795
Practice Address - Country:US
Practice Address - Phone:972-316-4555
Practice Address - Fax:972-316-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3213207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty