Provider Demographics
NPI:1235331661
Name:KEDIA, PRASHANT (MD)
Entity type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:
Last Name:KEDIA
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 1:221 W. COLORADO BLVD.
Mailing Address - Street 2:PAVILION II SUITE 630
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:469-695-2035
Mailing Address - Fax:469-695-2036
Practice Address - Street 1:221 W. COLORADO BLVD.
Practice Address - Street 2:PAVILION II SUITE 630
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:469-695-2035
Practice Address - Fax:469-695-2036
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1430207RG0100X, 207RG0100X
NY255771-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8ER441OtherBCBS TX