Provider Demographics
NPI:1396745311
Name:KIKKERI, NAGARAJ S (MD)
Entity type:Individual
Prefix:DR
First Name:NAGARAJ
Middle Name:S
Last Name:KIKKERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 CHILDRESS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2802
Mailing Address - Country:US
Mailing Address - Phone:972-681-7246
Mailing Address - Fax:972-681-8946
Practice Address - Street 1:3865 CHILDRESS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2802
Practice Address - Country:US
Practice Address - Phone:972-681-7246
Practice Address - Fax:972-681-8946
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2016-10-07
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TXK9584207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610792000OtherDEPT. OF LABOR
TX8R5340OtherBCBS KIKKERI INTERANTIONA
TX097018807Medicaid
TX8M0103OtherBCBS MPA
TX8K5591OtherBCBS MAA
TX8M0110OtherBCBS WRA
TX097018808Medicaid
TX8R5340OtherBCBS KIKKERI INTERANTIONA
TX8M0103OtherBCBS MPA
TX8B6780Medicare ID - Type UnspecifiedMESQUITE PROFESSIONAL
TX8K5591OtherBCBS MAA
TX8F1688Medicare ID - Type UnspecifiedKIKKERI INTERNATIONAL
TX8B6802Medicare ID - Type UnspecifiedMESQUITE ANESTHESIOLOGY