Individual
DR. SIVASANKER BAKTHAVACHALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4200 W UNIVERSITY DR, PROSPER, TX 75078-9805
(682) 303-4200
(682) 303-4242
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 303-7132
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
M6033
TX
Other
Enumeration date
05/25/2007
Last updated
05/09/2023
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