Provider Demographics
NPI:1790023901
Name:KUGASIA, IRFANALI RAJABALI (MD)
Entity type:Individual
Prefix:
First Name:IRFANALI
Middle Name:RAJABALI
Last Name:KUGASIA
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 1:2800 E BROAD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6411
Mailing Address - Country:US
Mailing Address - Phone:682-900-4174
Mailing Address - Fax:682-900-4175
Practice Address - Street 1:2800 E BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6411
Practice Address - Country:US
Practice Address - Phone:682-900-4174
Practice Address - Fax:682-900-4174
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3895207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3822763-01Medicaid