Provider Demographics
NPI:1952937187
Name:TEKMAL, SESHIDAR RAO
Entity Type:Individual
Prefix:
First Name:SESHIDAR
Middle Name:RAO
Last Name:TEKMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR.
Mailing Address - Street 2:DEPT OF MEDICINE, MCHE-MDX
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-4789
Mailing Address - Fax:210-916-6654
Practice Address - Street 1:3551 ROGER BROOKE DRIVE
Practice Address - Street 2:DEPT OF MEDICINE, MCHE-MDX
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4789
Practice Address - Fax:210-916-6654
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4860208D00000X, 207P00000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program