Provider Demographics
NPI:1881873982
Name:KESAVAN, DHANALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:DHANALAKSHMI
Middle Name:
Last Name:KESAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 W CAMPBELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2946
Mailing Address - Country:US
Mailing Address - Phone:972-449-7677
Mailing Address - Fax:972-449-7678
Practice Address - Street 1:3020 E HEBRON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4457
Practice Address - Country:US
Practice Address - Phone:972-695-9630
Practice Address - Fax:972-694-0000
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119161DGEMedicare PIN
NJ207240DGEMedicare PIN