Provider Demographics
NPI:1669583944
Name:MISHRA, ANURAG (MD)
Entity type:Individual
Prefix:MR
First Name:ANURAG
Middle Name:
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANURAG
Other - Middle Name:
Other - Last Name:MISRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 SMOKETREE TRL
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-7372
Mailing Address - Country:US
Mailing Address - Phone:630-847-8384
Mailing Address - Fax:877-334-1352
Practice Address - Street 1:6800 SMOKETREE TRL
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-7372
Practice Address - Country:US
Practice Address - Phone:630-847-8384
Practice Address - Fax:877-334-1352
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28283207RC0000X
TXN5249207R00000X
KS0425612207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100568Medicaid
IL036100568Medicaid
ILG86363Medicare UPIN