Individual
DR. KAMLESH J. SISODIYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5400 STATE HIGHWAY 121 STE 100, COLLEYVILLE, TX 76034-5929
(817) 479-1500
(817) 479-1504
Mailing address
1417 GABLES CT STE 201, PLANO, TX 75075-7648
(469) 326-5115
(469) 326-5119
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
K1931
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
K1931
TX
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
K1931
TX
208VP0000X
Pain Medicine Physician
K1931
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
K1931
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127663610
—
TX
01
—
8EL145
BCBS
TX
01
—
P01356074
RR
TX
Enumeration date
12/28/2005
Last updated
06/29/2021
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